Blood pressure dipping during REM and non-REM sleep in patients with moderate to severe obstructive sleep apnea

Abstract

A limited number of papers have addressed the association between non-dipping-blood pressure (BP) obstructive sleep apnea (OSA), and no study has assessed BP-dipping during rapid eye movement (REM) and non-REM sleep in OSA patients. This study sought to noninvasively assess BP-dipping during REM and non-REM (NREM)-sleep using a beat-by-beat measurement method (pulse-transit-time (PTT)). Thirty consecutive OSA patients (men = 50%) who had not been treated for OSA before and who had > 20-min of REM-sleep were included. During sleep, BP was indirectly determined via PTT. Patients were divided into dippers and non-dippers based on the average systolic-BP during REM and NREM-sleep. The studied group had a a median age of 50 (42–58.5) years and a body mass index of 33.8 (27.6–37.5) kg/m2. The median AHI of the study group was 32.6 (20.1–58.1) events/h (range: 7–124), and 89% of them had moderate-to-severe OSA. The prevalence of non-dippers during REM-sleep was 93.3%, and during NREM-sleep was 80%. During NREM sleep, non-dippers had a higher waist circumference and waist-hip-ratio, higher severity of OSA, longer-time spent with oxygen saturation < 90%, and a higher mean duration of apnea during REM and NREM-sleep. Severe OSA (AHI ≥ 30) was defined as an independent predictor of non-dipping BP during NREM sleep (OR = 19.5, CI: [1.299–292.75], p-value = 0.03). This short report demonstrated that BP-dipping occurs during REM and NREM-sleep in patients with moderate-to-severe OSA. There was a trend of more severe OSA among the non-dippers during NREM-sleep, and severe OSA was independently correlated with BP non-dipping during NREM sleep.

Towards Validating the Effectiveness of Obstructive Sleep Apnea Classification from Electronic Health Records Using Machine Learning

“…Sleep architecture is estimated by leveraging wearable sensors or smartwatches with machine learning methods and its effect on OSA screening is observed in [72,73]. Specifically, stage 1 and stage 3 sleep exhibited anomalous behavior in the case of OSA patients, as stated in [74][75][76]. Interestingly, the findings of our presented work does not reveal strong predictive powers when using the features of sleep stages (stage 1, stage 2, stage 3 and REM) as well as sleep duration metrics.…”

Toward Precision Medicine: Circadian Rhythm of Blood Pressure and Chronotherapy for Hypertension - 2021 NHLBI Workshop Report

“…143 Severe obstructive sleep apnea has been linked to nondipping BP. 144 Meta-analyses report that individuals with SDB have a 1.47 (95% CI, 1.21–2.28) increased odds of nocturnal hypertension. 145 Treatment of SDB with continuous positive airway pressure lowers nocturnal BP.…”

Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach

“…During sleep, the physiological response is dipping of BP, at least 10% of baseline, generally 10–20% across sleep [18 ▪ ]. When it does not occur or shows reversal, it is associated with an increased risk of hypertension, left ventricular hypertrophy, angina, myocardial infarctions and cardiac death [18 ▪ ].…”