Short-Term Antihypertensive Medication Does Not Exacerbate Sleep-Disordered Breathing in Newly Diagnosed Hypertensive Patients

Abstract

It has been speculated for some time that various antihypertensive medications may have a deleterious effect on respiration during sleep and thereby enhance the apparent association between hypertension and sleep apnea/hypopnea (SAH). However, there are few data to support this contention. The present study used a double-blind, randomized, cross-over design to contrast the effects of 6 weeks treatment with alpha-methyldopa and the combination of hydrochlorothiazide and amiloride with that of amlodipine and the combined diuretics in a group of 24 newly diagnosed patients with primary hypertension. All-night polysomnography was performed before the initiation of therapy (baseline) and at the end of the two treatment periods. Respiratory variables failed to reveal any significant differences between the treatments and baseline, or between the two different treatment regimens. The two treatment regimens achieved similar reductions in blood pressure. The prevalence of SAH was 25% before treatment, which is comparable to a prevalence of 20% in a similar group drawn from the same population but receiving various antihypertensive medications. The findings of this study are in agreement with previous reports using other classes of antihypertensive drugs that also failed to detect any tendency for increases in nocturnal respiratory disturbance indices over assessment periods of 8 weeks or shorter.

Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

“…Means and standard deviations (SD) for the OSA outcomes were extracted from preintervention and postintervention assessments. Medians were used to impute missing means and range/4 to impute missing SD 28,29 as prescribed in the metaanalysis literature. 30 A within-subject correlation of 0.4 was assumed between pre-post outcome measurements to approximate the SD of pre-post differences if not reported.…”

“…30 A within-subject correlation of 0.4 was assumed between pre-post outcome measurements to approximate the SD of pre-post differences if not reported. The severity of sleep apnea was reported as RDI in two trials 5,28 and AHI in the rest of the trials. Two trials reported posttreatment AHI or RDI for rapid eye movement (REM) and non-REM sleep separately; however, sufficient information was available to allow for computation of AHI or RDI based on total sleep time, which was then used in subsequent analyses.…”

“…5,29 There were large inconsistencies in the measures of nocturnal oxygenation used across the studies. Of the 11 studies that reported prenocturnal and postnocturnal oxygenation measurement values, 7 reported lowest oxygen saturation 22,28,29,[31][32][33][34] and 4 reported mean oxygen saturation, 22,29,32,35 but only 3 reported oxygen desaturation index 22,28,34 and only 2 reported hypoxic index. 35,36 Given the extent of missing data for these variables, we limited further analysis to the two variables with most complete data: lowest oxygen saturation and mean oxygen saturation.…”

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

“…No change of the AHI is observed with any class of antihypertensive drugs, including a-methyldopa and b blockers, which have central actions, Calcium (Ca) antagonists or angiotensin-converting enzyme (ACE) inhibitors, indicating that none of the known classes of antihypertensive drugs may exert any specific effect on OSAS itself. 32,33 An assessment conducted on a small number of patients showed that b blockers significantly reduced diastolic BP measured on clinical examination compared with Ca antagonists, ACE inhibitors, angiotensin receptor blockers and diuretics. Another report showed significant reduction of the nocturnal systolic and diastolic BP levels following treatment with b blockers compared with Ca antagonists, ACE inhibitors and angiotensin receptor blockers, although there was no significant difference in the degree of reduction of daytime BP during awakening, nor any difference compared with diuretics.…”

Alcohol, toxins, and medications as a cause of sleep dysfunction

“…Two studies have shown an increase in TST and SE (Bartel et al, 1997;Foral et al, 2003) on methyldopa and others have found decreased SWS and REM sleep (Foral et al, 2003). Two studies have shown an increase in TST and SE (Bartel et al, 1997;Foral et al, 2003) on methyldopa and others have found decreased SWS and REM sleep (Foral et al, 2003).…”