PS 17-20 YOUNG OBESE HYPERTENSIVE WITH REVERSE DIPPING UNMASKED UNDERLYING OBSTRUCTIVE SLEEP APNOEA

Abstract

Objective: Background: Obstructive Sleep Apnoea (OSA) is a common cause of reverse or non-dipping phenomenon which increase cardiovascular mortality. Untreated OSA later develops into systemic hypertension. Hence, OSA should be considered in young patient with hypertension. Case: A 17-year-old lady, with a body mass index of 34.7 kg/m2, was referred to investigate for young hypertension. Parents and siblings were not hypertensive. Grandparents developed hypertension at old age. Physical examination did not reveal any secondary cause. ECG showed sinus rhythm and not suggestive of left ventricular hypertrophy. Design and method: Investigation: A 24 hours blood pressure (BP) showed average BP of 138/87 mmHg, average daytime BP of 137/86 mmHg, average night-time BP of 144/91 mmHg, and reverse dipping pattern (-5.1%). Sphygmocor showed no increase in arterial stiffness. Aortic systolic blood pressure was 97 mmHg with aortic augmentation of 1 mmHg (1% at heart rate of 75). Epworth score was 14. Sleep study confirmed obstructive sleep apnoea. Biochemical tests, other investigations and imaging did not suggest any secondary causes of hypertension. Progression: Night continuous positive airway pressure (CPAP) was prescribed, however, usage was intermittent. After a year, hypertension did not worsen, BP persisted around 140/80 mmHg, and she did not need anti-hypertensives. Results: Discussion: Obesity is an emerging health problem. Obstructive sleep apnoea-related hypertension prevalence is rising but remains under-diagnosed. OSA patients treated with CPAP were shown to have reversal of structural changes in large vessels. However, untreated OSA and related hypertension can lead to cardiac structural changes and endothelial damage. In our patient, intermittent CPAP use prevented her worsening of hypertension. Conclusions: Conclusion:Delayed diagnosis of hypertension with obstructive sleep apnoea or failure of early treatment can cause cardiovascular consequences especially among young hypertensive patients. Obstructive sleep apnoea should be considered as a cause of hypertension in the young, especially in a setting of obesity.