PS 17-14 MORNING SURGE IN SLEEP APNEA-HYPOPNEA PATIENTS - ARE WE MISSING IT?

Abstract

Objective: There are two types of morning hypertension – nocturnal hypertensive morning hypertension and morning surge hypertension, both often associated with sleep apnea-hypopnea syndrome. The morning surge in blood pressure is influenced by the sympathetic nerve system. Aim was to determine which type of morning hypertension is more common in patients with sleep apnea-hypopnea syndrome. Design and method: Research included 100 patients who underwent polygraphic examination in UCC Kragujevac. According to AHI patients were divided into 4 equal groups, 25 patients each (AHI <5; 5–15; 15–30 and >30). Diagnosis of hypertension was made, and diurnal and nocturnal blood pressure profile was assessed using ABPM. Spectral analysis of heart rate variability, using a fast Fourier transform of the autoregression method integrated into 24h ECG Holter monitoring, was used for non-invasive testing of autonomic function. All data were statistically analyzed in the SPSS for Windows. Results: Study population consisted of 69% of male and 31% of female patients with mean age of 55.05 ± 11.16 years. Prior hypertension was present in 76% of patients (χ2 = 27.04; p = 0.000) in total group, with 68% on antihypertensive therapy (χ2 = 12.96; p = 0.000). Non-dipping of SBP was present in 37% of study population (x2 = 16.40; p = 0.007) and for DBP in 31% of patients in total group. Morning surge of blood pressure > 10 mmHg was present in 79% of patients (χ2 = 33.64; p = 0.000), with even more than 50% having rise > 20 mmHg. Mean morning surge was 24.25 ± 19.37 mmHg. LF/HF ratio was > 2.0 in 70% of patients confirming that autonomic balance is shifted towards sympathetic activity (χ2 = 12.96; p = 0.000). Conclusions: Non-dipping blood pressure profile was present in these patients causing the presence of nocturnal hypertensive mornig hypertension, but morning surge hypertension was more prevalent, probably due to sympathetic overactivity. Regardless of the type morning hypertension represents a major challenge in clinical practice, especially in sleep apnea-hypopnea syndrome.