Characteristics of hypertension in obstructive sleep apnea: An Asian experience

Hoshide, Satoshi; Chia, Yook Chin; Siddique, Saulat; Buranakitjaroen, Peera; Tsoi, Kelvin K.F.; Tay, Jam Chin; Turana, Yuda; Chen, Chen Huan; Huỳnh, Văn Minh; Park, Sungha; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Wang, Tzung‐Dau

doi:10.1111/jch.14184

Cited by 23 publications

(11 citation statements)

References 41 publications

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“…The positive association between SDB (OSA as the main component) and hypertension and DBP observed in our study was supported by other studies [26–28]. A population-based study showed that the risk of being hypertensive increased in a dose-dependent fashion with the severity of OSA [29].…”

Section: Discussionsupporting

confidence: 91%

Self-reported sleep-disordered breathing and insomnia in association with hypertension: a community-based study in Eastern China

Wang

Liu

et al. 2022

Blood Pressure Monitoring

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Objective We aimed to explore the associations of selfreported sleep-disordered breathing (SDB) and insomnia with hypertension based on a community-based survey among adults in Suzhou, Eastern China. MethodsThe Suzhou Food Consumption and Health Survey was conducted from 2018 to 2019. A multistage random sampling method was used to recruit potential participants. Associations of SDB and insomnia with hypertension were examined by multivariable logistic regression models with adjustment for covariates. In addition, sensitivity analysis was used to reinforce our findings.Results A total of 2728 participants were included in the final analysis. SDB (OR, 1.83; 95% CI, 1.44-2.34; P < 0.001) and insomnia (OR, 1.31; 95% CI, 1.04-1.65; P < 0.001) were significantly associated with prevalent hypertension after multivariable adjustments. In the subgroup analysis by age groups and sex, the association between SDB and hypertension persisted in all groups, whereas the association between insomnia and hypertension remained significant in males and different age groups. In addition, SDB was positively correlated with DBP. Notably, participants with comorbid SDB and insomnia had the highest risk for hypertension (OR, 1.95; 95% CI, 1.40-2.72; P < 0.001). ConclusionBoth SDB and insomnia were associated with the prevalence of hypertension among the Chinese adults, whereas the comorbid conditions conveyed the highest risk for hypertension. Our findings provide a new insight for the potential pathogenesis of hypertension and a prevention strategy of hypertension among community adults.

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Section: Discussionsupporting

confidence: 91%

Self-reported sleep-disordered breathing and insomnia in association with hypertension: a community-based study in Eastern China

Wang

Liu

et al. 2022

Blood Pressure Monitoring

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“…In line with previous reports, 29 hypertension and obesity were the most common modifiable CV risk factors in OSA patients in our study. Hence, in addition to adequately treating OSA, every effort should be made to control any residual hypertension and BP variability caused by OSA, 30 as well as mitigate the CV risk in obesity by weight loss, dietary control, regular exercise, which all are known to increase insulin sensitivity. Finally, it has been shown that in patients with moderate to severe OSA, CPAP not only improved central systolic BP, but also significantly reduced arterial stiffness derived from aortic PWV 31 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of hypertension and arterial stiffness in obstructive sleep apnea: A Scandinavian experience from a prospective study of 6408 normotensive and hypertensive patients

Saeed

Romarheim

Mancia

et al. 2022

J of Clinical Hypertension

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The impact of obstructive sleep apnea (OSA) on arterial stiffness is less studied.We aimed to investigate the prevalence and covariates of increased pulse pressure (PP), a surrogate marker of arterial stiffness, in the entire study population as well as in separate analyses in normotensive and hypertensive patients. Further, we also explored the impact of smoking on brachial BP in hypertensive patients. Between 2012 and 2019, a total of 6408 participants with suspected OSA underwent a standard out-of-center respiratory polygraphy. OSA was defined by an apnea-hypopnea index (AHI) ≥15/h regardless of symptoms. PP ≥60 mmHg was used as a surrogate marker of increased arterial stiffness. Mean age was 49.3±13.7 years, 69.4% were male, and 34.5% had OSA. The prevalence of hypertension was 70.8% in OSA and 46.7% in No-OSA (AHI < 15/h) controls (P < .0001). Hypertension was controlled (clinic BP < 140/90 mmHg) in 45.5% and uncontrolled in 54.5% (P < .001). Mean PP was 50±12 mmHg in smokers and 52±12 mmHg in non-smokers (P = .001). Increased PP was found in 24.2% of the entire study population and was higher in patients with OSA compared to No-OSA group (27.5% vs 22.4%, P < .0001). In an unadjusted logistic regression model, OSA was associated with a 1.3-fold higher risk of having increased PP (95% CI 1.16-1.48, P < .001). In a multivariable-adjusted model, higher age, male sex, and history of hypertension, but not OSA (OR 0.89; 95% CI 0.77-1.02, P = .104) were associated with increased PP. In this large study of nearly 6500 participants who were referred with suspected OSA, one-third were diagnosed with OSA and a quarter had increased arterial stiffness by elevated brachial PP. Hypertension but not OSA per se was associated with increased arterial stiffness. Hypertension was highly prevalent and poorly controlled.

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“…OSA is the most common global sleep-related breathing disorder, characterized by repetitive complete or partial collapse of the upper airways during sleep, causing sleep fragmentation, intermittent hypoxemia, multiple arousals and, consequently, increased renin-angiotensin-aldosterone and sympathetic system activity, triggering a variety of mechanisms that mediate several clinical consequences, including propensity to a nondipper circadian BP pattern [19][20][21] and 'hard' cardiovascular outcomes [5,22]. Risk factors for OSA include older age, male sex, obesity, and craniofacial/upper airway abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and associated factors of obstructive sleep apnea in refractory hypertension

Chedier

Roderjan

Cavalcanti

et al. 2022

Journal of Hypertension

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Background:Refractory hypertension (RfHT) and obstructive sleep apnea (OSA) share common pathophysiological mechanisms and probably are intrinsically associated, but their prevalence, clinical profile, and polysomnography (PSG) pattern remain misunderstood.Objective:To describe OSA prevalence and PSG pattern of patients with RfHT in a large cohort of resistant hypertension (RHT).Methods:This is a cross-sectional study involving 418 RHT patients (30.9% male; mean age of 62.5 ± 9.9 years) who were submitted to full-night PSG. RfHT was defined as uncontrolled ambulatory blood pressure monitoring using five or more antihypertensive drugs, including spironolactone. Bivariate analysis compared RHT and RfHT and multivariate analysis was performed to assess the independent correlates of OSA.Results:A total of 90 patients (21.5%) were diagnosed with RfHT (26.7% male; mean age of 58.5 ± 8.3 years). In comparison with resistant ones, RfHT patients were younger, with higher smoking and previous cardiovascular diseases prevalence, especially stroke. There was no difference regarding anthropometric measures. OSA prevalence (80.0 vs. 82.9%) and moderate/severe OSA (51.1 vs. 57.0%) were similar in both groups as well as apnea–hypopnea index. In its turn, refractory hypertensive patients presented better sleep efficiency (78 vs. 71%), with higher total sleep time (315 vs. 281 min) and lower sleep latency (11 vs. 17 min). There was no difference regarding rapid eye movement sleep, oxygen saturation, microarousals index, and periodic limb movement.Conclusion:In this large RHT cohort, resistant and refractory hypertensive patients have similar OSA prevalence, although refractory ones, which by definition use spironolactone, are younger and apparently have a better sleep pattern.

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Characteristics of hypertension in obstructive sleep apnea: An Asian experience

Abstract: This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 23 publications

References 41 publications

Self-reported sleep-disordered breathing and insomnia in association with hypertension: a community-based study in Eastern China

Self-reported sleep-disordered breathing and insomnia in association with hypertension: a community-based study in Eastern China

Characteristics of hypertension and arterial stiffness in obstructive sleep apnea: A Scandinavian experience from a prospective study of 6408 normotensive and hypertensive patients

Prevalence and associated factors of obstructive sleep apnea in refractory hypertension

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