Blutdruckmedikationskosten bei Patienten mit obstruktiver Schlafapnoe

Obstructive sleep apnea is one of the most common sleep disorder and causes excessive daytime sleepiness. In the adult population a prevalence of approximately 3-7% in men and 2-5% in women is as-sumed. Besides the reduction of quality of life of affected patients, their body is exposed an ongoing stress caused by the disturbed sleep structure. Viewed over a longer period, it causes high blood pressure and increased heart rate. Thus, the syndrome of obstructive sleep apnea represents a relevant cardiovascular risk factor. Therapy is held for nearly thirty years by CPAP-therapy and is now the gold standard for the treatment of obstructive sleep apnea syndrome. The therapeutic effect of CPAP-therapy on blood pressure is now well studied and documented. A successful CPAP-therapy leads to a sig-nificant reduction in blood pressure. Data concerning the effects on medicinal antihypertensive therapy and possible cost-saving effects were not investigated and are lacking until now. In the present study, the data of 726 patients from the Sleep Disor-ders Center, University Hospital Marburg, with obstructive sleep ap-nea and the beginning of CPAP-therapy were evaluated. At the be-ginning a diagnostic overnight with polysomnography was performed, connected 2 nights therapy were to set a CPAP-therapy. In the fol-low-up at 3 months, 527 of these patients presented again for poly-somnographic monitoring under CPAP-therapy. To the mentioned time points one complete polysomnographic evaluation of sleep and a measurement of blood pressure was conducted. Daytime sleepi-ness was assessed by Epworth Sleepiness Scale. The existing anti-hypertensive therapy was recorded and the daily treatment costs were calculated at the respective time points. The observed patients demonstrated after 3 months a significant im-provement in sleep quality, deeper stages of sleep and REM sleep was achieved significantly more frequently. Duration of NREM stages 56 1 and 2 decreased significantly. In the first eight diagnosis the RDI decreased from 35 to 4 (p <0.001), daytime sleepiness decreased significantly from 10.91 points to 6.52 points on the Epworth Sleepi-ness Scale (p <0.001). 56% of patients received, prior to initiation of therapy, drug antihyper-tensive therapy, usually a combination of two or more active ingredi-ents. Mainly used were ACE inhibitors, AT2 antagonists, beta-blockers, calcium antagonists and diuretics. The calculated daily treatment costs were approximately 0,37 euros for each patient. In the post-accident investigations patients under CPAP therapy showed significantly lower blood pressures, however, no significant change in drug therapy. A cost-saving effect could not be detected, the daily treatment costs rose significantly (from 0.37 € to 0.42 €, p <0.001). Besides, these patients showed improved setting of hyper-tension. The issue of improved blood pressure control is finally re-emphasized, as demonstrated in studies: With a reduction in blood pressure of about 10 mmHg, the risk of acute illness event of coro-nary heart disease decreases by 37% and the risk of stroke decreas-es by 56%. [35]. Concerning health economics, this constitutes an extremely significant fact considering the costs caused by hospitali-zation and rehabilitation after a stroke or myocardial infarction.