Sleep Apnea and Hypertension: Interactions and Implications for Management

Kapa, Suraj; Kuniyoshi, Fatima H. Sert; Somers, Virend K.

doi:10.1161/hypertensionaha.106.076190

Cited by 80 publications

(68 citation statements)

References 38 publications

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“…Udwadia and colleagues demonstrated in their study that although an association of SDB with hypertension was significant, multiple logistic regression analysis did not select hypertension as a principle covariate. 25 However, a high prevalence of hypertension in sleep apnoea has been unequivocally demonstrated in the present study as well as other studies [19][20][21] and emphasises the role of early diagnosis and treatment of sleep apnoea patients as well as the importance of evaluating all the newly diagnosed sleep apnoeic patients for hypertension.…”

Section: -21supporting

confidence: 72%

Hypertension and catecholamine levels in sleep apnoea

Vardhan

Shanmuganandan

2012

Medical Journal Armed Forces India

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BACKGROUNDSleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association. METHODIn this sleep clinic-based study, 82 newly diagnosed patients of sleepdisordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP). RESULTSThe prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoeahypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catecholamines in both the cases. CONCLUSIONHypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.

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Section: -21supporting

confidence: 72%

Hypertension and catecholamine levels in sleep apnoea

Vardhan

Shanmuganandan

2012

Medical Journal Armed Forces India

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“…Several factors may affect the relationship between BP and OSA, including age and sex [27,28]. OSA is associated with hypertension more strongly in young to middle-aged adults (,50 yrs of age) than in older adults [13,29], as confirmed by population-based cross-sectional [7] and longitudinal [13] studies.…”

Section: Association Of Osa With Hypertension and Hypertension With Osamentioning

confidence: 79%

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Parati

Lombardi²,

Hedner³

et al. 2013

Eur Respir J

211

132

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on behalf of the EU COST Action B26 members ABSTRACT: This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of cardiovascular diseases (in particular arterial hypertension) in OSA patients. The present document is the result of work performed by a panel of experts participating in the European Union COST (Cooperation in Scientific and Technological research) Action B26 on OSA, with the endorsement of the European Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

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“…6 There is growing evidence that OSA participates in the genesis of hypertension through several mechanisms, including sympathetic overactivation, oxidative stress, systemic inflammation, and increased arterial stiffness. 7,8 The treatment of OSA with continuous positive airway pressure (CPAP) is able to reduce BP in patients with OSA and sustained hypertension. 8 However, patients with OSA frequently present several comorbid conditions, and the treatment of OSA rarely normalizes BP to the point that antihypertensive medications can be discontinued.…”

mentioning

confidence: 99%

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

et al. 2011

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Abstract-Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43Ϯ7 years; body mass index, 28.8Ϯ3.0 kg/m 2 ) with untreated severe obstructive sleep apnea (apnea-hypopnea index, 56Ϯ22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; nϭ18) or CPAP (nϭ18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126Ϯ5 to 121Ϯ7 mm Hg; Pϭ0.001) and a trend for diastolic blood pressure (from 75Ϯ7 to 73Ϯ8 mm Hg; Pϭ0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (PϽ0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; Pϭ0.02) and masked hypertension (from 39% to 5%; Pϭ0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.

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Sleep Apnea and Hypertension: Interactions and Implications for Management

Cited by 80 publications

References 38 publications

Hypertension and catecholamine levels in sleep apnoea

Hypertension and catecholamine levels in sleep apnoea

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

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