Clinical trial NCT06446934: AKTIIA OBPM to Assess CPAP Effect on Blood Pressure in Obstructive Sleep Apnea
Official title: Continual Optical Cuffless Monitoring to Assess the CPAP Therapeutic Effect on Blood Pressure in Obstructive Sleep Apnea Patients
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Hypertension
Cardiac Function and Hemodynamics
Usability
Patient Experience
Keywords: Hypertension
Obstructive Sleep Apnea
Blood Pressure Monitors
Continuous Positive Airway Pressure
Echocardiography
Pulse Wave Analysis
Photoplethysmography
Telemedicine
Lead sponsor: Hospital Universitario Araba
Sponsor class: OTHER
Collaborators: name: Bioaraba Health Research Institute
First posted: 2024-06-06
Enrollment: 90
Sex: ALL
Minimum age (years): 25
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Single-center, single-arm, interventional pre-post design study
Primary purpose: TREATMENT

Brief summary: The goal of this clinical trial is to learn if positive airway pressure (CPAP) therapy works for blood pressure (BP) control in obstructive sleep apnea (OSA) adult patients plus undiagnosed hypertension (HBP), using a cuffless bracelet for continual optical BP monitoring (AKTIIA OBPM).

It will also learn if CPAP improves cardiac function in these patients using speckle tracking echocardiography (STE) and to learn about ease of use and patient experience with AKTIIA device and AKTIIA OBPM.

The main questions it aims to answer are:

* Does CPAP reduce systolic BP (and other BP metrics) in this population?
* Does CPAP improve cardiac function in the same population? Researchers will compare BP metrics derived from AKTIIA OBPM and STE metrics in a before and after CPAP therapy to evaluate its therapeutic effect.

Participants will:

* Take a CPAP titration and telemonitoring program for 12 weeks (from the titration date)
* Take an AKTIIA OBPM one week before CPAP and 12 weeks since CPAP titration date
* Take a STE test twice, before starting CPAP and 12 weeks after CPAP titration date
* Take an online survey about easy of use and patient experience with AKTIIA OBPM device

Detailed description: Patients with moderate-severe OSA, indication for CPAP therapy and undiagnosed hypertension will be included. If the patient meets all the inclusion criteria and none of the exclusion criteria, he/she will be considered a candidate for the study. Once the informed consent has been signed, a visit will be made to initiate continuous blood pressure monitoring with the AKTIIA system (AKTIIA OBPM). The first week (week 0, preCPAP) serves to confirm the presence of HBP (average BP 130/80+ mmHg and/or average nocturnal BP 120/70+ mmHg).

If the participant has HBP criteria, an speckle tracking echocardiography (STE) will be performed (preCPAP) and then CPAP treatment will be initiated following the sleep unit´s telemonitoring care program with initial ambulatory pressure titration. If the participant do not have HBP criteria, only CPAP treatment will be started.

The CPAP titration date will be day 1 for AKTIIA OBPM and CPAP monitoring. At 12 weeks of monitoring, a second STE will be scheduled (post-CPAP) and the end-of-study on-site visit is performed to assess: efficacy and adherence to CPAP, clinical and BP control in the AKTIIA OBPM (week 12, post-CPAP).

Finally, an anonymous electronic survey on AKTIIA device usability and patient experience with AKTIIA OBPM and CPAP therapy will be conducted.

Withdrawal criteria are: ineffective CPAP titration, CPAP dropout, invalid AKTIIA OBPM or dropout, prescription of antihypertensive drug, patient decision or PI decision and loss of contact.

Researchers will compare pre-post CPAP blood pressure metrics (systolic BP as the main parameter), circadian profile, dynamic metrics, STE metrics, efficacy and CPAP adherence, symptoms (ESS, QOL own scales) and subgroup analysis by gender, age, OSA severity or CPAP adherence.

Eligibility criteria: Inclusion Criteria:

* Adults 25-70 years old
* Moderate-severe OSA (AHI 15+)
* First prescription of CPAP therapy
* Undiagnosed HBP
* Smartphone use and technological skills
* Informed consent

Exclusion Criteria:

* Antihypertensive drug
* Cardiovascular comorbidity: atrial fibrilation, heart failure, ischemic heart disease, stroke
* Reduced perfusion (e.g. Raynaud)
* Severe/Advanced chronic disease
* Central apnea
* Pregnancy
* Shift work
* Other social issues: misunderstanding/miscommunication

Primary outcomes:
measure: Change from baseline in the AKTIIA OBPM systolic blood pressure (SBP) at 12 weeks
timeFrame: 1 week pre-CPAP and 1 week post-CPAP at the end of 12 weeks AKTIIA OBPM
Secondary outcomes:
measure: Change from baseline in the left ventricular global longitudinal strain (LV-GLS) at 12 weeks
timeFrame: Baseline prep-CPAP and at the end of 12 weeks AKTIIA OBPM
Other outcomes:
measure: Change from OSA diagnosis in Epworth Sleepiness Scale scoring at 12 weeks
timeFrame: Baseline at OSA diagnosis (pre-CPAP) and at the end of 12 weeks AKTIIA OBPM (post-CPAP)
measure: Usability of AKTIIA system and Patient Experience with AKTIIA OBPM at 12 weeks
timeFrame: At the end of 12 weeks AKTIIA OBPM
Locations:
city: Vitoria-Gasteiz
country: Spain
facility: Hospital Universitario Araba
state: Araba
Study officials:
affiliation: Hospital Universitario Araba
name: Mikel Azpiazu, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Sola J, Cortes M, Perruchoud D, De Marco B, Lobo MD, Pellaton C, Wuerzner G, Fisher NDL, Shah J. Guidance for the Interpretation of Continual Cuffless Blood Pressure Data for the Diagnosis and Management of Hypertension. Front Med Technol. 2022 May 17;4:899143. doi: 10.3389/fmedt.2022.899143. eCollection 2022.
citation: Tadic M, Gherbesi E, Faggiano A, Sala C, Carugo S, Cuspidi C. The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta-analysis of echocardiographic studies. J Clin Hypertens (Greenwich). 2022 Jul;24(7):795-803. doi: 10.1111/jch.14488. Epub 2022 Jun 13.
citation: Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007 Aug;50(2):417-23. doi: 10.1161/HYPERTENSIONAHA.106.085175. Epub 2007 Jun 4.
citation: Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009 Jan 3;373(9657):82-93. doi: 10.1016/S0140-6736(08)61622-0. Epub 2008 Dec 26.