The Factors Affecting the Non-dipper Pattern in Japanese Patients with Severe Obstructive Sleep Apnea

Abstract

Objective Obstructive sleep apnea (OSA) is assumed to influence the circadian blood pressure (BP) fluctuation, particularly causing nocturnal hypertension and changing the dipping pattern of nocturnal BP. This study aimed to clarify the triggers of the non-dipper pattern in nocturnal BP in Japanese patients with severe OSA (the apnea-hypopnea index ≥30/h). Methods Of 541 patients with OSA diagnosed using polysomnography (PSG) and ambulatory BP monitoring (ABPM), 163 patients <60 years of age (Younger group) and 101 patients ≥60 years of age (Older group) were stratified into the dipper or non-dipper pattern groups. Results A logistic regression analysis was performed using a non-dipper pattern as a dependent variable. A multivariate analysis demonstrated that the cumulative percentage of time at saturation below 90% was the only independent risk factor for the non-dipper and riser patterns in the Younger group (odds ratio, 1.022; 95% confidence interval, 1.001-1.044; p=0.035), whereas slow-wave sleep (odds ratio, 0.941; 95% confidence interval, 0.891-0.990; p=0.019) and the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (odds ratio, 2.589; 95% confidence interval, 1.051-6.848; p=0.039) were risk factors in the Older group. Conclusion These findings suggested that the degree of desaturation in young OSA patients and sleep quality in old OSA patients might influence the dipping patterns in nocturnal BP.

Ambulatory blood pressure monitoring and diabetes complications

“…Since sleep apnea and degree of desaturation during sleep may influence the dipping pattern. [ 48 ] One important limitation of this study is the small sample size in some combination of exposure and outcome for example the number of patients with CVD and normal dipping status was 4, which resulted in imprecise OR estimate with wide CI as well sparse data bias (OR inflation). We note that the magnitude of sparse data bias is not expected to be high as there is no huge OR estimate in our study and the number of events per variable is >4 for all models.…”

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

“…After the initial search of titles and abstracts, 659 papers were excluded and 90 were reviewed. Of these, 14 studies [15,16,17,18,19,20,21,22,23,24,25,26,27,28] fulfilled the inclusion criteria and comprised sufficient data to be enclosed in the present review (Figure 1).…”

“…The night-time period was defined according to five different criteria (data from 13 studies). Day–time and night-time periods were classified according to an individual’s diary in six studies [19,23,24,26,27,28]. Fixed time intervals were used to define the night-time period in the remaining studies: 10.00 PM–6.00 AM (four studies) [15,17,21,25], 10.00 PM–7.00 AM [18], 11.00 PM–6.00 AM [20], and 12.00 PM–6.00 AM [16].…”

“…OSA was defined according to the apnea/hypo-apnea index (AHI) cut-off of ≥15 events/h in eight studies, ≥5 events/h in six studies, and ≥30 events/h in one study. Diagnosis of OSA was made out-of-hospital by unattended home sleep recordings via polysomnography in four studies [15,20,26,28] and by polygraphy in three studies [21,24,27], respectively, and in the hospital setting (sleep laboratory) in the other seven studies [16,17,18,19,22,23,25] by using different commercial devices.…”

Serum hs-CRP, YKL-40 and brain-derived neurotrophic factor (BDNF) associated biomarkers in non-dipper hypertension profile?

“…Among these obstructive sleep apnoea and sleep quality were shown to influence the pattern of blood pressure in young and older hypertensive patients. (5) Other research has investigated alterations in dysfunctional endothelium in response to changes in mechanical stress and the manner in which humoral factors can link inflammation with hypertension. (6) Human Chitinase3-like1 (YKL-40, also known as human cartilage glycoprotein 39) belongs to the pentraxin family of proteins, stimulating cellular proliferation; it's role is explored as a non-disease-distinct inflammatory biomarker and/or tissue remodelling.…”