Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring

Genta-Pereira, Daniel Castanho; Furlan, Sofia F.; Omote, Daniel Q.; Giorgi, Dante Marcelo Artigas; Bortolotto, Luiz Aparecido; Lorenzi‐Filho, Geraldo; Drager, Luciano F.

doi:10.1161/hypertensionaha.118.11525

Cited by 49 publications

(44 citation statements)

References 39 publications

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“…After the initial search of titles and abstracts, 659 papers were excluded and 90 were reviewed. Of these, 14 studies [15,16,17,18,19,20,21,22,23,24,25,26,27,28] fulfilled the inclusion criteria and comprised sufficient data to be enclosed in the present review (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Cuspidi

Tadić

Sala

et al. 2019

JCM

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Aim: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). Design: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: “obstructive sleep apnea”, “sleep quality”, “non dipping”, “reduced nocturnal BP fall”, “circadian BP variation”, “night-time BP”, and “ambulatory blood pressure monitoring”. Results: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0–90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0–65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07–1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21–2.28, p < 0.001). Conclusions: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping.

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Section: Methodsmentioning

confidence: 99%

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Cuspidi

Tadić

Sala

et al. 2019

JCM

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“…Nevertheless, the aim of this study was to investigate which parameters influence the development of the HP at sleep onset, not OSA as a disease. Therefore, like in other studies, the criterion C of the international classification of sleep disorders was applied (American Academy of Medicine,, 2014;Genta-Pereira et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients

et al. 2020

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Introduction: Obstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors. Methods:We analyzed beat-to-beat measurements of hemodynamic parameters (HPs) during a 25-min period of wake-sleep transition. Differences in the mean HP values for heart rate (HR), systolic BP (SBP), and stroke volume (SV) during wake and sleep and their standard deviations (SDs) were compared between 34 controls (C) and 22 OSA patients. The Student's t-test for independent samples and the effect size by Cohen's d (d) were calculated. HP evolution was investigated by plotting the measured HP values against each consecutive pulse wave. After a simple regression analysis, the calculated coefficient beta (SCB) was used to indicate the HP evolution. We furthermore explored by a hierarchical block regression which variables increased the prediction for the SCB: model 1 BMI and age, model 2 + apnea/hypopnea index (AHI), and model 3 + arousal index (AI).Results: Between the two groups, the SBP increased in OSA and decreased in C resulting in a significant difference (p = 0.001; d = 0.92). The SV demonstrated a similar development (p = 0.047; d = 0.56). The wake/sleep variation of the HP measured by the SD was higher in the OSA group-HR: p < 0.001; d = 1.2; SBP: p = 0.001; d = 0.94; and SV: p = 0.005; d = 0.82. The hierarchical regression analysis of the SCB demonstrated in SBP that the addition of AI to AHI resulted in R 2 : +0.163 and F + 13.257 (p = 0.001) and for SV R 2 : +0.07 and F 4.83 (p = 0.003). The AI but not the AHI remained statistically significant in the regression analysis model 3-SBP: β = 0.717, p = 0.001; SV: β = 0.469, p = 0.033. Frontiers in Physiology | www.frontiersin.org 1 March 2020 | Volume 11 | Article 104 Staats et al. Sleep Fragmentation and Hemodynamic DippingConclusion: In this study, we demonstrated that in OSA, the physiological dipping in SBP and SV decreased, and the variation of all investigated parameters increased. Hierarchical regression analysis indicates that the addition of the AI to BMI, age, and AHI increases the prediction of the HP evolution following sleep onset for both SBP and SV and may be the most important variable.

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“…The Accutracker II device showed satisfactory accuracy and precision according to available documentation at the time of investigation in the early 1990s. As described elsewhere 12,13 , non-dipping was defined as nighttime:daytime BP ratio > 0.90. Reversed nocturnal BP dipping (nighttime:daytime BP ratio > 1.00) and extreme nocturnal BP dipping (nighttime: aytime BP ratio ≤ 0.80) patterns were regarded as non-dippers and dippers, respectively.…”

Section: Prevalence Of Hypertension and Ambulatory Blood Pressure Monmentioning

confidence: 99%

Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men

Tan

Lind

Ingelsson

et al. 2020

Sci Rep

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Chronically blunted nocturnal blood pressure (BP) dipping has been shown to increase the future risk of cardiovascular diseases. In the present cross-sectional study, we investigated whether selfreported insomnia symptoms were associated with an altered 24-h BP profile and blunted nocturnal BP dipping (night-today BP ratio > 0.90) in older men. For the analysis, we used 24-h ambulatory blood pressure data and reports of insomnia symptoms (difficulty initiating sleep, DIS; and early morning awakenings, EMA) from 995 Swedish men (mean age: 71 years). Compared to men without DIS, those reporting DIS (10% of the cohort) had a higher odds ratio of diastolic non-dipping (1.85 [1.15, 2.98], P = 0.011). Similarly, men who reported EMA (19% of the cohort) had a higher odds ratio of diastolic non-dipping than those without EMA (1.57 [1.09, 2.26], P = 0.015). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+ 1.4 mmHg, P = 0.042), no other statistically significant differences in BP and heart rate were found between men with and those without insomnia symptoms. Our findings suggest that older men reporting difficulty initiating sleep or early morning awakenings may have a higher risk of nocturnal diastolic non-dipping. Our findings must be replicated in larger cohorts that also include women.

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Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring

Cited by 49 publications

References 39 publications

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients

Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men

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