Phenotypic characteristics associated with hypertension in patients with obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) causes secondary hypertension. However, the reasons why the prevalence of hypertension among OSA patients varies widely (35-70%) are not clear. We sought to investigate the phenotypic characteristics of patients with and without hypertension among OSA patients who were matched for disease severity. We studied 152 OSA patients (76 normotensive and 76 hypertensive) diagnosed by polysomnography. Detailed phenotypic characteristics, including laboratorial analysis, were determined in all patients. Univariate analysis followed by multiple logistic regression analysis was used to identify variables that were independently associated with hypertension. The apnea-hypopnea index in normotensive and hypertensive patients was similar (48726 and 48726 events/ h, respectively) as well as minimum arterial oxygen saturation (76710 and 75710%, respectively) and total sleep time with oxyhaemoglobin saturation o90% (25725 and 28726%, respectively). Hypertensive patients were older (57711 vs 47712 years; Po0.001), had a higher body mass index (BMI; 3477 vs 3075 kg/m 2 ; Po0.001), had a higher frequency of women (37 vs 8%; Po0.001), had a higher incidence of diabetes (25 vs 6%; P ¼ 0.002) and a higher family history of hypertension (75 vs 42%; P ¼ 0.01) than did the normotensive patients. Multiple logistic regression analysis indicated that age (P ¼ 0.004), familial history of hypertension (P ¼ 0.004), BMI (P ¼ 0.04) and female sex (P ¼ 0.03) were the independent variables associated with hypertension. We concluded that increasing age and BMI, familial history of hypertension as well as female gender are phenotypic characteristics associated with hypertension among OSA patients with similar disease severity.

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

“…33 Whether risk factors such as obesity, age, and sex play a role in the relationship between hypertension and OSA remains elusive. [34][35][36][37] …”

Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis

“…14,35 In the present study, we characterized not only the relative impact of OSA on validated markers of early atherosclerosis 36 -39 but also the impact of the concomitant HTN, a very common condition associated with OSA. 12, 13 We described previously that severe OSA and HTN are associated with arterial stiffness and heart structure abnormalities of (1) waist circumference Ն102 cm in men and Ն88 cm in women; (2) triglycerides Ն150 mg/dL or patient on specific drug treatment; (3) highdensity lipoprotein cholesterol Ͻ40 mg/dL in men and Ͻ50 mg/dL in women or when on specific drug treatment; (4) arterial blood pressure Ն130 or 85 mm Hg for systolic and diastolic blood pressure, respectively, or patient on antihypertensive drug treatment; and (5) fasting glucose Ն100 mg/dL or patient on specific drug treatment. .…”

“…12 In patients with OSA, the prevalence of HTN is Ϸ40%, and the presence of HTN could be the result of the interaction of environmental and genetic factors. 13 HTN is a well-known condition associated with atherosclerosis, 14 and the coexistence of OSA and HTN may have additive effects on the risk of atherosclerosis.…”

Sleep Apnea and Hypertension: Interactions and Implications for Management

“…8 Female rats subjected to intermittent hypoxic insults were less at risk for developing elevated blood pressure than their male or ovariectomized female counterparts. However, a recent study by Drager et al 9 suggested that increasing age, body mass index, a family history of hypertension, and female gender independent of menopause and obesity may be risk factors for hypertension in patients with OSA. The apnea-hypopnea index has also been suggested to be associated more closely with impaired conduit and resistance vessel function in women than in men.…”