Abstract
BackgroundUntreated Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is a known factor contributing to resistant hypertension (HT). Continuous Positive Airways Pressure (CPAP) is effective to decrease blood pressure (BP) in severe OSAHS. In our clinical practice, hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS). We aimed to confirm that severe OSAHS is less symptomatic in HT patients than normotensive patients using ESS.MethodsWe retrospectively compared two age, gender-matched groups - 100 hypertensive patients and 100 normotensive patients - with severe OSAHS defined as an AHI (Apnea Hypopnea Index) ≥30. OSAHS was considered symptomatic when ESS > 10.ResultsThe two groups of patients did not differ significantly with respect to main characteristics including Body Mass Index (BMI), AHI and ODI (Oxygen Desaturation Index). Systolic and Diastolic BP were higher in HT patients (p < 0.01). HT patients were less symptomatic with regard to severe OSAHS with a lower ESS (10.0 vs 11.9, p < 0.01), and a lower number of patients with an ESS > 10 (30% vs 58%, p < 0.01). In multivariable analysis adjusted on age, gender, Obesity, Systolic BP, Diastolic BP, AHI and ADO, normotension was significantly associated with symptomatic OSAHS (OR = 2.83, [1.298–6.192], p < 0.01).ConclusionsIn our study on patients with severe OSAHS, ESS score was lower in hypertensive patients than in normotensive patients. This discrepancy may lead to an underestimation of severe OSAHS in hypertensive patients.
Highlights
Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is widely acknowledged as a common chronic pathology, but to date it has remained under-diagnosed [1, 2]
Both groups are matched in terms of both age and gender.The database contains the following items: an anonymized checklist of patients examined for an OSAHS; the polysomnography data (Apnea Hypopnea Index: AHI and Oxygen Desaturation Index: ODI); the Epworth Sleepiness Scale (ESS) score; the main clinical paraclinical parameters; and when available, treatment in progress
AHI Apnea Hypopnea Index ESS Epworth Sleepiness Scale ODI Oxygen Desaturation Index HT Hypertensive non HT patients (n = 100) 55, 13 65, 65% 34, 8 62, 62% 4, 4% 6, 6% 11.9, 3.5 58, 58% 45.2, 15,5 37.3, 20.1 124, 9 70, 10 p 0.24 1 0.41 0.72 . . < 0.01 < 0.01 0.91 0.74 < 0.01 < 0.01 hypertensive group compared to the normotensive group (SBP: 138 mmHg vs 124 mmHg, p < 0.01 and Diastolic Blood Pressure (DBP): 80 mmHg vs 70 mmHg, p < 0.01)
Summary
Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is widely acknowledged as a common chronic pathology, but to date it has remained under-diagnosed [1, 2]. It is estimated that more than half the cases with OSAHS are It is recognized amongst scientific circles that OSAHS constitutes a major risk factor for both elevated blood pressure [7] and for developing resistant HT [8]. Several studies have demonstrated that hypertensive patients with OSAHS have a higher risk of developing cardiovascular events than those without it [9,10,11], and that Continuous Positive Airway Pressure therapy (CPAP) improves blood pressure control in compliant patients (≥ 4 h per night) [12, 13]. Hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS).
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