Obstructive sleep apnoea during REM sleep and incident non-dipping of nocturnal blood pressure: a longitudinal analysis of the Wisconsin Sleep Cohort

Mokhlesi, Babak; Hagen, Erika W.; Finn, Laurel; Hla, Khin Mae; Carter, Jason R.; Peppard, Paul E.

doi:10.1136/thoraxjnl-2015-207231

Cited by 114 publications

(102 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data from the Wisconsin Sleep Cohort Study indicate a dose-response increase in the development of nondipping hypertension with severity of SDB at baseline when followed for 7 years [11], which was confirmed by a recent report demonstrating that in patients attending a cardiology clinic with known cardiovascular disease and moderate or severe OSA there is a 4% increase in the odds of having a nondipping blood pressure profile per unit increase in AHI [4]. Further recent data from the Wisconsin Cohort indicate that SDB during rapid eye movement sleep is particularly associated with a nondipping nocturnal blood pressure pattern [12].…”

supporting

confidence: 63%

Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms

2017

View full text Add to dashboard Cite

Obstructive sleep apnoea (OSA) is highly prevalent, with recent general population studies indicating that up to 50% of males and 23% of females have moderate or severe sleep disordered breathing (SDB) based on an apnoea-hypopnoea index (AHI) of >15 events·h -1 [1, 2]. OSA is recognised as an independent risk factor for systemic hypertension [3] and a nondipping nocturnal blood pressure profile is particularly likely in patients with OSA [4], even in the absence of significant hypertension. Furthermore, hypertension is increasingly recognised as an important predictor of prevalent OSA and appears to be more predictive than excessive day-time sleepiness in some settings [5]. However, recent evidence also indicates that only moderate-severe OSA (AHI >20 events·h -1 ) constitutes a significant independent risk for hypertension [2] and cluster analysis of sleep clinic populations indicates that particular population subtypes are especially associated with hypertension [6].These recent reports regarding the very high general prevalence of SDB and factors that influence the relationship with hypertension prompt a reassessment of the clinical relevance regarding the association between OSA and hypertension, especially nocturnal hypertension, and the underlying mechanisms that may contribute to the development of a nondipping nocturnal blood pressure profile in OSA patients. This topic is important in the context of the recent SAVE (Sleep Apnea Cardiovascular Endpoints) trial report [7] involving 2717 patients with established cardiovascular disease and moderate or severe OSA associated with minimal sleepiness who were randomised to best usual care with or without added continuous positive airway pressure (CPAP) therapy and followed for up to 7 years. CPAP therapy was not associated with any improvement in cardiac or cerebrovascular outcome, although data on secondary and other end-points in the report indicated a small but significant reduction in diastolic blood pressure. This finding is particularly relevant in the context that the average compliance with CPAP was only 3.3 h and a recent meta-analysis indicates that beneficial effects of CPAP on blood pressure in OSA patients with minimal sleepiness are largely confined to patients using CPAP for >4 h per night [8].

show abstract

supporting

confidence: 63%

Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms

2017

View full text Add to dashboard Cite

show abstract

“…Apnea events are of longer duration and are associated with a greater degree of hypoxemia in REM vs. NREM sleep (Findley et al, 1985, Muraki et al, 2008, Series et al, 1990). Significant longitudinal relationships were found for REM-AHI with hypertension development (Mokhlesi et al, 2014) and the risk of developing nocturnal non-dipping blood pressure (Mokhlesi et al, 2015). We report that AHI was worse in REM vs. NREM sleep, and accordingly, patients were at a high risk for the aforementioned consequences of REM-related OSA.…”

Section: Discussionmentioning

confidence: 99%

Effects of a lifestyle intervention on REM sleep‐related OSA severity in obese individuals with type 2 diabetes

Shechter

Foster

Lang

et al. 2017

Journal of Sleep Research

View full text Add to dashboard Cite

The current aim was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid-eye movement (REM) sleep, and to determine if longitudinal changes in glycemic control are related to changes in OSA severity during REM sleep over a 4-yr follow-up. This was a randomized-controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea-hypopnea index (AHI) during REM sleep (REM-AHI) and non-REM sleep (NREM-AHI), and glycated hemoglobin (HbA1c) at baseline and year-1, year-2, and year-4 follow-ups. Mean baseline values of REM-AHI were significantly higher than NREM-AHI in both groups. Both REM-AHI and NREM-AHI were significantly more reduced in ILI vs. DSE, but these differences were slightly attenuated after adjustment for weight changes. Repeated-measure mixed-model analyses including data through year 4 demonstrated that changes in HbA1c were significantly related to changes in weight but not to changes in REM-AHI and NREM-AHI. Compared to control, the ILI reduced REM-AHI and NREM-AHI across the 4-year follow-up. Weight, as opposed to REM-AHI and NREM-AHI, were related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycemic control in T2D patients with OSA.

show abstract

“…Why CPAP then failed to unveil any chronotherapeutic advantage with evening dosing may be attributable to suboptimal CPAP compliance. Several studies have highlighted the importance of rapid eye movement (REM) sleep in the pathophysiology of hypertension in OSA 27 49 50. In our current study with relatively poor CPAP compliance, it is possible that persistent OSA during the latter half of REM-predominant sleep may have continued to mask any potential chronotherapeutic benefit with evening dosing.…”

Section: Discussionmentioning

confidence: 85%

Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial

Serinel

Yee

Grunstein

et al. 2016

Thorax

View full text Add to dashboard Cite

show abstract

Obstructive sleep apnoea during REM sleep and incident non-dipping of nocturnal blood pressure: a longitudinal analysis of the Wisconsin Sleep Cohort

Abstract: Our findings indicate that in a population-based sample, REM OSA is independently associated with incident non-dipping of BP.

Cited by 114 publications

References 34 publications

Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms

Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms

Effects of a lifestyle intervention on REM sleep‐related OSA severity in obese individuals with type 2 diabetes

Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial

Contact Info

Product

Resources

About