CHEST
Contemporary Reviews in Sleep MedicineRelationship Between OSA and Hypertension
Section snippets
OSA and the Incident Risk of Hypertension
Epidemiologic studies show that patients with OSA have a high prevalence of obesity.2, 11 Therefore, obesity may be the nexus that explains the high prevalence of hypertension in these patients. However, the results of a large, prospective, longitudinal study, the Wisconsin Sleep Cohort Study (WSCS), suggest that moderate to severe OSA (apnea-hypopnea index [AHI] > 15/h) is an independent cause of hypertension. Subjects with this degree of OSA severity showed a 3.2-fold increase in the odds of
Circadian Pattern of BP in Patients With OSA
Studies involving 24-h ambulatory BP monitoring (ABPM) have shown that subjects with hypertension with a decrease in BP of ≤ 10% during the night (nondippers) and those who present an increase in BP at night (risers)23 exhibit greater organ damage and worse cardiovascular outcomes than do subjects with hypertension who present a decrease of > 10% during the night (dippers).24, 25 Initial case-control studies using 24-h ABPM showed that patients with OSA had a high prevalence of an unfavorable
OSA and Resistant Hypertension
Resistant hypertension is defined as the clinical situation in which lifestyle changes plus pharmacologic treatment with three drugs (including a diuretic) fail to lower the BP to below 140/90 mm Hg.23, 40 Depending on the population studied, the prevalence of this condition ranges from 5% to 30% of subjects with hypertension.40
The reported data have shown a high prevalence of OSA in patients with resistant hypertension (71%-83%).5, 41 In a study that included 125 subjects with resistant
CPAP Treatment
Many studies have evaluated the effect of CPAP treatment on BP in patients with OSA (Fig 1). However, most of these studies evaluated short-term effects and had important limitations and design differences.45 These differences and limitations can be divided into two categories. One set of factors depends on the study population, such as age, sex, BMI, hypertension degree, and adequate antihypertensive treatment, as well as OSA severity. Another set of factors depends on the methodology, such as
Effects of Hypertension Treatment on OSA
According to the available physiopathologic knowledge of the relationship between OSA and hypertension, antihypertensive drugs that modulate sympathetic activity and the renin-angiotensin-aldosterone axis may be the best treatment options for hypertension in patients with OSA. To date, the studies that have evaluated the effects of antihypertensive drug treatment on OSA severity have included small subject samples and no comparable populations, and they have had important methodologic
Conclusions and Future Directions
There is an epidemiologic relationship between OSA and hypertension that is especially important in subjects with resistant hypertension. Despite this, the causal relationship between OSA and hypertension is probably not as important as initially thought. Certain population characteristics, such as age, sleepiness associated with OSA, and sex, may be important in determining the role of OSA as a cause of hypertension. OSA may also lead to the development of an unfavorable circadian pattern of
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Barbé received research grants from ResMed, Australia, a company that develops products related to sleep apnea; the Health Research Fund, Spanish Ministry of Health; the Spanish Respiratory Society (SEPAR); the Catalonian Cardiology Society, Esteve-Teijin (Spain); Oxigen Salud (Spain); and ALLER to develop the ISAACC clinical trial (NCT01335087). Drs Torres and Sánchez-de-la-Torre have
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2023, Sleep MedicineCitation Excerpt :As such, it is imperative to better understand the validity of hypoxia measures in Type III sleep testing to better gauge the role of sleep apnea-specific hypoxia and health outcomes in hospitalized patients with OSA. Lastly, several risk factors have been associated with increased risk for moderate to severe OSA, and data has consistently found BMI and cardiovascular diseases, such as stroke, CAD, and HTN, to be associated with OSA [36–44]. In our inpatient cohort, BMI, CAD, atrial fibrillation, diabetes, and COPD were identified as risk factors in well-performing predictive models for varying OSA diagnostic thresholds and sleep related hypoxia by inpatient sleep study type in women versus men.
originally published Online First April 16, 2015.
FUNDING/SUPPORT: This study was funded by Fondo de Investigación Sanitaria [PI10/02763, PI10/02745, and PI14/01266], the Spanish Respiratory Society (SEPAR), and Associació Lleidatana de Respiratori (ALLER).
© 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.