Abstract
PurposeHypertension is a common finding in patients with obstructive sleep apnea (OSA), but it has remained unclear whether or not the amount of disturbed breathing and characteristics of individual respiratory events differ between hypertensive and normotensive patients with severe OSA.MethodsFull polysomnographic recordings of 323 men and 89 women with severe OSA were analyzed. Differences in the duration of individual respiratory events, total apnea and hypopnea times, and the percentage of disturbed breathing from total sleep time (AHT%) were compared between normotensive and hypertensive patients separately by genders. Furthermore, differences in the respiratory event characteristics were assessed between three AHT% groups (AHT% ≤ 30%, 30% < AHT% ≤ 45%, and AHT% > 45%).ResultsHypertensive women had lower percentage apnea time (15.2% vs. 18.2%, p = 0.003) and AHT% (33.5% vs. 36.5%, p = 0.021) when compared with normotensive women. However, these differences were not observed between hypertensive and normotensive men. Percentage hypopnea time was higher in hypertensive men (13.5% vs. 11.2%, p = 0.043) but not in women (15.2% vs. 12.2%, p = 0.130) compared with their normotensive counterparts. The variation in AHI explained 60.5% (ρ = 0.778) and 65.0% (ρ = 0.806) of the variation in AHT% in normotensive and hypertensive patients, respectively. However, when AHT% increased, the capability of AHI to explain the variation in AHT% declined.ConclusionsThere is a major inter- and intra-gender variation in percentage apnea and hypopnea times between hypertensive and normotensive patients with severe OSA. OSA is an important risk factor for hypertension and thus, early detection and phenotyping of OSA would allow timely treatment of patients with the highest risk of hypertension.
Highlights
Obstructive sleep apnea (OSA) is a heterogeneous nocturnal breathing disorder with significant public health consequences [1]
The evaluation of the differences in the total apnea time, total hypopnea time, total apnea+hypopnea time, AT%, HT%, AHT%, and durations of obstructive apneas, central apneas, mixed apneas, and hypopneas between different pools of patients was done with analysis of covariance (ANCOVA) adjusted for age, body mass index (BMI), and apnea-hypopnea index (AHI)
Even though no statistically significant differences were seen in the AHI or oxygen desaturation index (ODI), hypertensive patients had longer total hypopnea times (44.4 min vs. 35.6 min, pMWU = 0.020, pA = 0.027) and higher HT% (14.2% vs. 11.3%, pMWU = 0.003, pA = 0.031) when compared with normotensive patients (Table 1)
Summary
Obstructive sleep apnea (OSA) is a heterogeneous nocturnal breathing disorder with significant public health consequences [1]. OSA is characterized by partial (hypopneas) and complete (apneas) breathing cessations, usually leading to arousals resulting in sleep fragmentation and excessive daytime sleepiness [2] as well as recurrent but transient declines in blood oxygen saturation [3]. Due to these facts, OSA is an established risk factor for cardiovascular diseases, hypertension, and even mortality [4]. A more detailed disease characterization, e.g., taking into account the durations of apneas and hypopneas, could improve the estimation of risk of OSA-related health consequences [13, 14] and the identification of those individuals who would gain the greatest benefits from different therapies
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