0465 Difficulty initiating and maintaining sleep is associated with increased blood pressure in people with obstructive sleep apnea

Abstract

Abstract Introduction Approximately 30-50% of people with obstructive sleep apnea (OSA) have difficulty initiating and/or maintaining sleep (DIMS). The co-occurrence of OSA and DIMS is associated with worse mental health and quality of life compared to OSA alone. This study investigated potential associations between OSA and regular sleep disturbances (defined over multiple months) with blood pressure and hypertension. Methods A validated under-mattress sleep analyzer (WITHINGS) monitored sleep in 12,287 participants over ~6-months at home. The mean apnea-hypopnea index (AHI), sleep onset latency (SOL) and wake after sleep onset (WASO) were calculated over the recording period. OSA was defined as an average AHI ≥ 15 events/hour. DIMS was defined as an average SOL ≥30 min and/or WASO ≥ 45min. Participants were categorized into those with neither condition (control), OSA-alone, DIMS-alone, and OSA+DIMS. Blood pressure measurements were recorded using a home monitor to define hypertension based on mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between OSA+DIMS and hypertension were investigated using regression analyses controlled for age, sex, and BMI. Results Participants were middle-aged (Mean±SD; 50±12 y), mostly men (88%) and overweight (BMI; 28±6 kg∙m-2). The prevalence of DIMS-alone, OSA-alone and OSA+DIMS was 10%, 21% and 8%, respectively. OSA-alone was associated with (mean [95%CI]) 4.5 [4.1, 5.0] and 2.6 [2.3, 2.93] mmHg higher systolic and diastolic blood pressure values compared to control. OSA+DIMS was associated with a 5.9 [5.3, 6.6] and 3.7 [3.3, 4.2] mmHg difference compared to control, and the increased difference was greater than OSA-alone (systolic: +1.4 [0.8, 2.0]; diastolic: +1.12 [0.7, 1.6] mmHg; p-values < 0.001).Furthermore , OSA-alone and OSA+DIMS were associated with a 37 [22 to 54] and a 60 [36 to 88] % increase in hypertension prevalence compared to control, respectively. OSA+DIMS had a greater increase in hypertension prevalence (17% [-1 to 38%]) compared to OSA-alone. Conclusion OSA when combined with difficulties initiating and maintaining sleep, consistent with insomnia symptomology, was associated with higher blood pressure and increased hypertension prevalence compared to OSA-alone. Support (if any)