Abstract
We directly compared sleep apnoea (SA) rates and risk of cardiovascular and mortality outcomes among SA patients with resistant hypertension (RH) and non-RH within a large diverse hypertension population. A retrospective cohort study between 1 January 2006 and 31 December 2010 among hypertensive adults (age ≥ 18 years) was performed within an integrated health system. Rates of SA in RH and non-RH were determined. Multivariable logistic regression analyses were used to calculate OR for SA. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) for cardiovascular and mortality outcomes between SA in RH versus SA in non-RH adjusting for age, gender, race, BMI, chronic kidney disease and other comorbidities. SA was identified in 33 682 (7.2%) from 470 386 hypertensive individuals. SA in RH accounted for 5806 (9.6%) compared to SA in non-RH 27 876 individuals (6.8%). Multivariable OR (95% CI) for SA was 1.16 (1.12, 1.19), 3.57 (3.47, 3.66) and 2.20 (2.15, 2.25) for RH versus non-RH, BMI ≥ 30, and males, respectively. Compared to SA in non-RH individuals, SA in RH had a multivariable adjusted HR (95% CI) of 1.24 (1.13, 1.36), 1.43 (1.28, 1.61), 0.98 (0.85, 1.12) and 1.04 (0.95, 1.14) for ischaemic heart event (IHE), congestive heart failure (CHF), stroke and mortality, respectively. We observed a modest increase in likelihood for SA among RH compared to non-RH patients. Risks for IHE and CHF were higher for SA in RH compared to SA in non-RH patients; however, there were no differences in risk for stroke and mortality.
Highlights
In multivariable logistic regression analyses adjusting for age, sex, race, body mass index (BMI) and the presence of comorbidities, the OR for sleep apnoea (SA) in resistant hypertension (RH) compared to nonRH was 1.16 (1.12–1.19) (Table 2)
We found that the risk for cardiovascular outcomes was increased in SA subjects with RH compared with those with non-RH
In evaluating SA versus no SA, we found that among the RH population, SA was associated with an hazard ratios (HRs) of 1.08 (1.03–1.14) for all events compared to no SA
Summary
Sleep apnoea (SA) has been identified as one of the most common comorbidities associated with the development of resistant hypertension (RH).[1,2,3,4] While SA is believed to occur in up to 5–20% of the adult population, rates as high as 37–56% have been described in the hypertensive population.[5,6,7,8] The severity of hypertension (HTN) has been shown to increase with the severity of SA.[9,10,11] treatment of SA has been shown to improve blood pressure among hypertensive populations.[12,13,14]The prevalence and prognosis of SA among RH compared to non-RH has not been well described. We directly compared sleep apnoea (SA) rates and risk of cardiovascular and mortality outcomes among SA patients with resistant hypertension (RH) and non-RH within a large diverse hypertension population. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) for cardiovascular and mortality outcomes between SA in RH versus SA in non-RH adjusting for age, gender, race, BMI, chronic kidney disease and other comorbidities. Compared to SA in non-RH individuals, SA in RH had a multivariable adjusted HR (95% CI) of 1.24 (1.13, 1.36), 1.43 (1.28, 1.61), 0.98 (0.85, 1.12) and 1.04 (0.95, 1.14) for ischaemic heart event (IHE), congestive heart failure (CHF), stroke and mortality, respectively. Risks for IHE and CHF were higher for SA in RH compared to SA in non-RH patients; there were no differences in risk for stroke and mortality
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