Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Treatment Resistant Hypertension

Abstract

The article by Friedman et al1 in the present issue of Hypertension represents a thoughtfully designed study. Their report connects previously established but loosely connected lines of research into a coherent and credible theme with important therapeutic and research implications. First, treatment-resistant hypertension is associated with obstructive sleep apnea. Many patients with treatment-resistant hypertension are abdominally obese and insulin resistant, which is also characteristic of most patients with clinically significant obstructive sleep apnea (OSA). However, body weight and neck girth do not appear to explain the strength of the association between treatment-resistant hypertension and OSA. Of note, the roles of increased abdominal girth and insulin resistance (hyperinsulinemia), which are associated with increased aldosterone and incident sleep apnea,2,3 as potential mediators of the treatment-resistant hypertension-OSA relationship, are not addressed.4,5 Nevertheless, the importance of the observation of greater overnight rostral fluid shift and severity of OSA …