Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea in Prevalent Hypertension

Abstract

Due to frequent abnormal breathing events and their effects on sleep architecture, patients with obstructive sleep apnea (OSA) exhibit decreased amounts of slow wave sleep (SWS). Reduced SWS has been linked to hypertension in community-based studies. We sought to investigate whether SWS percentage modifies the association between OSA and prevalent hypertension. We studied 7107 patients with OSA and 1118 primary snorers who underwent in-laboratory polysomnography. Patients were classified into quartiles of percent SWS. Hypertension was defined based either on clinic blood pressure measures or on physician diagnosis. Multivariable logistic regression model showed a significant interaction effect of OSA and SWS on prevalent hypertension ( P =0.002). Decreased SWS was associated with higher odds for hypertension in OSA but not in primary snoring, with patients with OSA exhibiting <0.1% SWS (OR, 1.44 [95% CI, 1.21–1.70]; P =0.001) and those with 0.1% to 4.8% SWS (OR, 1.20 [95% CI, 1.03–1.40]; P =0.02) being more likely to have hypertension compared with those with >11.1% SWS. In analysis stratified by OSA severity, significant associations between percent SWS and blood pressure emerged only in moderate and severe OSA. Effect modifications by sex ( P =0.040) and age ( P =0.007) were also only evident in OSA, indicating that decreased SWS was associated with hypertension only in men and in patients <60 years old. Decreased SWS is associated with a dose-dependent increase in odds of prevalent hypertension in patients with OSA. The effects of SWS are likely to be modulated by OSA severity. SWS may be implicated in the heightened risk of cardiovascular diseases exhibited by patients with OSA.

Slow-wave sleep is associated with incident hypertension in patients with obstructive sleep apnea: a cross-sectional study

“…Furthermore, we found an association between combined OSA and SWS and prevalent hypertension. The higher mean incidence of hypertension (50.2%, 575/1145) observed in our study compared with the three studies mentioned above 17 – 19 could be explained by the patients with primary snoring and OSA in our cohort. Another study showed that the incidence of hypertension in patients with suspected OSA was 50.8% in 2018, 27 which is in accordance with our study.…”

“…The authors in this previous study found that the protective effect of SWS on hypertension was highest in quartile 3, not in quartile 4. A recent study 19 showed a significant relationship between SWS and OSA in prevalent hypertension for the first time, and SWS was associated with elevated BP in a dose-dependent manner in OSA. Our findings are consistent with these previous findings.…”

“… 17 However, few studies have focused on the effect of sleep architecture on the development of hypertension. 19 …”

An interesting link between quality of sleep and a measure of blood pressure variability

“…22 The "sleep architecture" characterizes the distribution of different stages of sleep and is reportedly related to the risk of cardiovascular diseases. 23 In the present study, the authors showed that higher visit-to-visit BP variability was associated with sleep architecture as reflected by reduced REM sleep duration, thereby suggesting a possible interesting link between quality of sleep and a parameter of long-term BP variability. 22 Concerning the relevant mechanisms of the BP variability in healthy subjects, inflammation induced by sleep disturbances might be another potential pathogenic mechanism.…”

Association between comorbid sleep apnoea–hypopnoea syndrome and prognosis of intensive care patients: a retrospective cohort study

“…1 SAHS is one form of sleep-related breathing disorder, which encompasses obstructive sleep apnoea (OSA), 2 3 mixed sleep apnoea, 4 central sleep apnoea (CSA) 5 and sleep-related hypoventilation. 1 SAHS is a common comorbidity in patients with various diseases and is a risk factor for congestive heart failure, 6 7 myocardial infarction, 8 9 hypertension, [10][11][12] diabetes mellitus, [13][14][15] chronic obstructive pulmonary disease (COPD) [16][17][18][19] and cerebral disease, 20 which are also reasons for intensive care unit (ICU) admission.…”