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Device-Guided Paced Respiration as an Adjunctive Therapy for Hypertension in Obstructive Sleep Apnea: A Pilot Feasibility Study

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Abstract

Data suggest that device-guided paced respiration (<10 breaths/min) may reduce blood pressure in hypertensive patients. We hypothesized that daily device-guided slow breathing may lower blood pressure in patients with hypertension and obstructive sleep apnea (OSA). In this one-arm pilot study, we enrolled 25 subjects with hypertension and OSA. Subjects were asked to perform device-guided paced respiration 30 min a day for 8 weeks. Our primary outcome was change in office systolic and diastolic blood pressures from baseline to 8 weeks. Twenty-four subjects completed the study. Mean baseline blood pressure was 140.0 ± 10.2 mmHg systolic and 82.7 ± 8.9 mmHg diastolic. Complete device data were available for 17 subjects. Mean device adherence was 81 ± 24% and 51% achieved a mean breath rate ≤10 breaths/min over 8 weeks. Three subjects had changes in their anti-hypertensive medications during the study. Among the remaining 21 subjects, mean difference in office blood pressure from baseline to 8 weeks was −9.6 ± 11.8 mmHg systolic (p ≤ 0.01) and −2.52 ± 8.9 mmHg diastolic (p = 0.21). Device-guided paced respiration may lower systolic blood pressure in patients with hypertension and OSA; however, our findings need to be confirmed with larger randomized controlled trials.

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Acknowledgments

This work was supported by an investigator-initiated grant from Philips-Respironics. Dr. Bertisch was supported by an Institutional National Research Service Award (T32AT00051-06) and by a career development award (1 K23 AT005104-01) from the National Center for Complementary and Alternative Medicine (NCCAM), NIH. Dr. Malhotra was supported by grants from the NHLBI (R01 HL73146, R01 HL085188-01, R01 HL090897-01, K24 HL 093218) and the American Heart Association (AHA 0840159 N). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI, NCCAM, or the National Institutes of Health.

Conflicts of Interest

Dr. Bertisch has received consulting fees from Philips. Dr. Malhotra has received consulting and/or research income from Philips, Ethicon, Apnex, SGS, SHC, Merck, Apnicure, Medtronic, Pfizer, Cephalon, Sepracor. Dr. Baloa, Lauren Hueser and Stephen Pittman are employees of Philips. This study investigated an off-label use of bi-level positive airway pressure (BiPAP® Pro 2, Philips Respironics, Murrysville, PA).

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Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1309 Beacon Street, 2nd floor, Brookline, Boston, MA, 02446, USA

    Suzanne M. Bertisch

  2. Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Suzanne M. Bertisch, Ashley Schomer, Erin E. Kelly & Atul Malhotra

  3. Philips Home Healthcare Solutions, Boston, MA, USA

    Leonardo A. Baloa, Lauren E. Hueser & Stephen D. Pittman

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  1. Suzanne M. Bertisch
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  2. Ashley Schomer
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  3. Erin E. Kelly
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  4. Leonardo A. Baloa
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  5. Lauren E. Hueser
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  6. Stephen D. Pittman
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  7. Atul Malhotra
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Correspondence to Suzanne M. Bertisch.

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Bertisch, S.M., Schomer, A., Kelly, E.E. et al. Device-Guided Paced Respiration as an Adjunctive Therapy for Hypertension in Obstructive Sleep Apnea: A Pilot Feasibility Study. Appl Psychophysiol Biofeedback 36, 173–179 (2011). https://doi.org/10.1007/s10484-011-9158-x

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