Abstract
Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.
Highlights
The worldwide prevalence of hypertension (HT) has been estimated to be as high as 1 billion individuals
Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained
Global perceived health (GPH) is an important outcome in nursing care, incorporating depression, insomnia and daytime sleepiness as crucial components [6], of which all are associated with Obstructive sleep apnea (OSA) in patients referred to sleep clinics, and with poor health perceptions in the general population [7]
Summary
The worldwide prevalence of hypertension (HT) has been estimated to be as high as 1 billion individuals. A suggested mechanism is the increased cardiovascular stress (i.e., sympathetic activation) caused by the breathing related events (i.e., the apneas/hypopneas that causes hypoxia) [3]. Another suggested cause is the high and increasing prevalence of obesity [4]. Global perceived health (GPH) is an important outcome in nursing care, incorporating depression, insomnia and daytime sleepiness as crucial components [6], of which all are associated with OSA in patients referred to sleep clinics, and with poor health perceptions in the general population [7]. The purpose of this study was 1) to describe the prevalence of different severity levels of OSA in adults with HT in primary care, and 2) to explore the contributions of OSA to subjective insomnia and daytime sleepiness, depressive symptoms and GPH in patients with undiagnosed OSA
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