Abstract
Obstructive sleep apnea (OSA) and short sleep duration are individually associated with an increased risk for hypertension (HTN). The aim of this multicenter cross-sectional study was to test the hypothesis of a cumulative association of OSA severity and short sleep duration with the risk for prevalent HTN. Among 1,499 patients undergoing polysomnography for suspected OSA, 410 (27.3%) previously diagnosed as hypertensive and taking antihypertensive medication were considered as having HTN. Patients with total sleep time (TST) <6 h were considered to be short sleepers. Logistic regression procedures were performed to determine the independent association of HTN with OSA and sleep duration. Considering normal sleepers (TST ≥6 h) without OSA as the reference group, the odds ratio (OR) (95% confidence intervals) for having HTN was 2.51 (1.35–4.68) in normal sleepers with OSA and 4.37 (2.18–8.78) in short sleepers with OSA after adjustment for age, gender, obesity, diabetes, depression, current smoking, use of thyroid hormones, daytime sleepiness, poor sleep complaint, time in bed, sleep architecture and fragmentation, and study site. The risk for HTN appeared to present a cumulative association with OSA severity and short sleep duration (p<0.0001 for linear trend). The higher risk for HTN was observed in short sleepers with severe OSA (AHI ≥30) (OR, 4.29 [2.03–9.07]). In patients investigated for suspected OSA, sleep-disordered breathing severity and short sleep duration have a cumulative association with the risk for prevalent HTN. Further studies are required to determine whether interventions to optimize sleep may contribute to lower BP in patients with OSA.
Highlights
Systemic hypertension (HTN) is a highly prevalent condition associated with significant morbidity, increased mortality and high economic cost
Further studies are required to determine whether interventions to optimize sleep may contribute to lower blood pressure (BP) in patients with Obstructive sleep apnea (OSA)
We separately studied the association of HTN with OSA alone and with short sleep duration alone
Summary
Systemic hypertension (HTN) is a highly prevalent condition associated with significant morbidity, increased mortality and high economic cost. There has been growing evidence in support of an independent association between sleep disorders and HTN. Obstructive sleep apnea (OSA) is strongly associated with HTN. A doseresponse relationship between OSA severity and HTN has been well documented by cross-sectional and longitudinal studies in both community- and clinic-based populations [2,3,4,5,6]. There is growing evidence that the diagnosis of an association between OSA and HTN, as well as the need for their combined treatment, should be considered, in patients with refractory HTN [8,9,10,11]. Sympathetic overactivity is considered to be a key factor in the pathogenesis of OSA-associated HTN [12, 13]
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