Relationship between sleep apnea syndrome and sleep blood pressure in patients without hypertension

Sekizuka, Hiromitsu; Kida, Kenji; Akashi, Yoshihiro J.; Yoneyama, Kihei; Osada, Naohiko; Omiya, Kazuto; Miyake, Fumihiko

doi:10.1016/j.jjcc.2009.10.002

Cited by 24 publications

(20 citation statements)

References 32 publications

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“…Also, there are a few studies employing ambulatory 24-hour BP monitoring (ABPM) instead of single time-point BP measurement, but these typically included a number of subjects two orders lower than in the current study. In a group of 47 consecutive patients, Sekizuka et al 31 report a significantly higher morning BP measured minutes after awakening and a higher nocturnal BP in se-OSA than in non se-OSA groups. Similarly, Cho et al 32 note that both morning SBP and DBP positively correlated with AHI, with a trend toward slightly higher correlation quotient for DBP, in a group of 58 patients with naïve hypertension.…”

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confidence: 95%

“…Our findings on the relationship between BP and AHI may be weakened by the occurrence of masked hypertension in patients with OSA (ie, some patients with normal clinical BP actually may have had an elevated ABPM, which would otherwise strengthen this relationship). 34 However, these three studies did not correct for the possible confounding effect of sex, age, or BMI on the associations, although Sekizuka et al 31 mentioned a possible interplay between high BP, OSA, and obesity. Yet, future studies should adopt this approach (ie, combining PSG and ABPM, when examining larger groups of normotensive OSA patients) to deepen the understanding of the relationship between breathing disturbances during sleep and BP circadian variability.…”

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confidence: 99%

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Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study

Mokros

Kuczyński

Franczak

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: The aim of the study is to verify a possible association between arterial blood pressure and obstructive sleep apnea (OSA) severity in a group of non-hypertensive patients. Methods: This is a retrospective study of 1,171 consecutive patients referred to the sleep laboratory with complaints suggestive of OSA who underwent standard diagnostic polysomnography. In total, 454 patients with no history of arterial hypertension nor had received any such treatment were selected from this group. Results: Patients with severe OSA (apnea-hypopnea index [AHI] ≥ 30 events/h) presented with higher diastolic blood pressure (DBP) in the morning than healthy subjects (AHI < 5 events/h) or those suffering from mild (15 < AHI ≥ 5 events/h) or moderate OSA (30 < AHI ≥ 15 events/h): 86.2 ± 11.3 versus 79.2 ± 8.5, 80.3 ± 10.2 and 81.4 ± 9.6 mmHg, P < .01, respectively. In a linear regression model, a rise in morning DBP was predicted by AHI (ß = 0.14, P < .001) and body mass index (BMI) (ß = 0.22, P < .01), but not by age (ß = 0.01, P = .92), male sex (ß = −0.06, P = .19), or smoking (ß = 0.01, P = .86). In contrast, no association existed between morning systolic blood pressure (SBP) and AHI independently of BMI, sex, age, or smoking. High blood pressure (ie, SBP ≥ 140 mmHg or DBP ≥ 90 mmHg on each of three measurements on different occasions) was predicted by age of 42 years or older, BMI of at least 29 kg/m 2 , and severe OSA. Conclusions: High AHI, independent of obesity, age and sex, was associated with elevated DBP in the morning. Thus, elevated morning DBP may be one of the symptoms related to OSA that warrants specific diagnostics. Commentary: A commentary on this article appears in this issue on page 861. Keywords: apnea-hypopnea index, body mass index, morning blood pressure Citation: Mokros Ł, Kuczyński W, Franczak Ł, Białasiewicz P. Morning diastolic blood pressure may be independently associated with severity of obstructive sleep apnea in non-hypertensive patients: a cross-sectional study. J Clin Sleep Med. 2017;13(7):905-910.

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Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study

Mokros

Kuczyński

Franczak

et al. 2017

Journal of Clinical Sleep Medicine

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“…The result of this study is similar to that of our previous study. 4 It has been reported that nocturnal hypertension contributes to the occurrence of cardiovascular disease and target organ damage. 1,2 Many investigators have reported that the risk of sudden death, heart failure or acute myocardial infarction increases during sleep in obstructive SAS patients.…”

Section: Influential Factors In Circadian Bp Changesmentioning

confidence: 99%

“…Treatment of SAS prevents sleep BP elevation. 4 Along with this treatment, improvement of lifestyle and eating habits is required to lower BP and improve abnormal lipid metabolism and glucose tolerance. Both of these factors probably prevent nocturnal hypertension, a risk factor for the onset of cardiovascular events.…”

Section: Influential Factors In Circadian Bp Changesmentioning

confidence: 99%

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Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

et al. 2010

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Chronic kidney disease (CKD) is common disease in patients with sleep apnea syndrome (SAS), which is considered to be responsible for secondary and nocturnal hypertension. In this study, we assessed blood pressure (BP) changes in SAS patients with CKD. Of 460 Japanese outpatients with suspected SAS who underwent ambulatory BP monitoring within 3 months of overnight polysomnography, 198 patients (172 males and 26 females) who were not receiving treatment with antihypertensives or nitroglycerin were enrolled. The estimated glomerular filtration rate (eGFR) was calculated, and the patients were stratified into the high (H; eGFRX60 ml min À1 per 1.73 m 2 ) or the low (L; eGFRo60 ml min À1 per 1.73 m 2 ) group. The patients in the L group were significantly older than those in the H group (Po0.001), and body mass index was significantly smaller in the L group than in the H group (P¼0.025). The rate of patients treated with statin (P¼0.030) and the levels of both triglyceride (P¼0.006) and creatinine (Po0.001) differed significantly between the two groups. The sleep data, 24-h BP, awake BP and morning BP showed no significant differences between the two groups. However, sleep systolic and diastolic BPs were significantly higher in the L group (122.5±16.7 mm Hg and 81.1±12.2 mm Hg, respectively) than in the H group (117.1±11.8 mm Hg, P¼0.033; and 76.1±9.5 mm Hg, P¼0.012, respectively). SAS patients with CKD had elevated sleep BP. This result suggests that appropriate treatments for both SAS and CKD prevent sleep BP elevation, which is considered a risk factor for the onset risk of a cardiovascular event. Keywords: ambulatory blood pressure monitoring; circadian blood pressure; estimated glomerular filtration rate; nocturnal hypertension; polysomnography INTRODUCTIONIt is important to consider blood pressure (BP) outside of a clinic setting when treating patients with hypertension, because BP measurements obtained in a clinic setting are not representative of BP outside of the clinic setting. Abnormal changes in circadian BP are considered to increase the risk of cardiovascular event. Patients with nocturnal hypertension or a morning BP surge tend to have a higher incidence of silent cerebrovascular disease 1 and greater intima-media and relative wall thickness compared with normotensive patients. 2 Nocturnal hypertension and morning BP surge are induced by sleep disordered breathing, which can be observed in 22% of Japanese adult males. 3 Typical clinical features of BP changes in patients with sleep disordered breathing and those with sleep apnea syndrome (SAS) are nocturnal hypertension and non-dipper patterns of circadian BP. As the severity of SAS increases, sleep BP is elevated even in a patient whose BP is within the normal range in the clinic. Moreover, the incidence of nocturnal cardiovascular events while sleeping increases in these patients. [4][5][6] Chronic kidney disease (CKD) seems to be tightly linked with nocturnal hypertension and morning BP surge. 7 CKD poses a high risk for the onset of cardiovascu...

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Pathology of unexpected sudden cardiac death: Obstructive sleep apnea is part of the challenge

Ottaviani

Buja

2020

Cardiovascular Pathology

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Relationship between sleep apnea syndrome and sleep blood pressure in patients without hypertension

Abstract: The results of this study suggested that SAS affected nocturnal BP elevation even in SAS patients without HTN. The diurnal BP showed no difference in the severity of SAS; however, the severe-SAS group revealed significant nocturnal BP elevation.

Cited by 24 publications

References 32 publications

Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study

Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

Pathology of unexpected sudden cardiac death: Obstructive sleep apnea is part of the challenge

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