Obstructive Sleep Apnea and Hypertension

Abstract

Obstructive sleep apnea (OSA) is the most severe form of sleep-disordered breathing (SDB) (Benninger and Walner, Clin Cornerstone 9:s6–12, 2007), which encompasses all forms of abnormal breathing during sleep (Marcus, Curr Opin Pediatr 12:208–12, 2000). Adults with OSA have a significant association with cardiovascular disease, specifically hypertension (HTN) (Somers et al. Circulation 118:1080–111, 2008). The relationship between systemic HTN and OSA is well documented (Lavie et al. BMJ 320:479–82, 2000, Nieto et al. JAMA 283:1829–36, 2000, Peppard et al. N Engl J Med 342:1378–84, 2000), and one particular prospective population study, the Wisconsin Sleep Cohort Study, documented OSA preceded and predicted the development of HTN (Peppard et al. N Engl J Med 342:1378–84, 2000). OSA has also been associated with drug-resistant HTN in adults (Grote et al. J Hypertens 18:679–85, 2000, Logan et al. J Hypertens 19:2271–7, 2001) which may be partially mediated by aldosterone (Calhoun et al. Chest 125:112–7, 2004, Pratt-Ubunama et al. Chest 131:453–9, 2007). The relationship between OSA and HTN is so well defined in adults that OSA is now recognized as an identifiable cause of HTN and should be considered during the evaluation for elevated blood pressure (BP) (Chobanian et al. Hypertension 42:1206–52, 2003). The National High Blood Pressure Education Program Working Group made a similar recommendation to screen for OSA as a comorbid condition in children with HTN (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, Pediatrics 114:555–76, 2004). However, the relationship between SDB and HTN is not as clear in children. Regardless, there is evidence to suggest an association between these two conditions. There is also evidence suggesting an independent effect of SDB on left ventricular geometry changes which improve after treatment of SDB. Obesity is a suspected confounder in the associations between SDB, HTN, and left ventricular geometry changes, but the interaction and causal relationship is still unknown.KeywordsSleep-disordered breathingSleep apneaHypertensionBlood pressureLeft ventricular hypertrophyChildren and adolescents