Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study.

Johns Hopkins University, Baltimore, Maryland, United States
Circulation (Impact Factor: 14.43). 02/2005; 111(5):614-21. DOI: 10.1161/01.CIR.0000154540.62381.CF
Source: PubMed


Sleep-disordered breathing (SDB) is associated with hypertension in the middle-aged. The association is less clear in older persons. Most middle-aged hypertensives have systolic/diastolic hypertension, whereas isolated systolic hypertension (ISH) is common among persons over 60 years. Mechanistically, only systolic/diastolic hypertension is expected to be associated with SDB, but few studies of SDB and hypertension distinguish systolic/diastolic hypertension from ISH. Prior investigations may have underestimated an association between SDB and systolic/diastolic hypertension in the elderly by categorizing individuals with ISH as simply hypertensive.
We conducted cross-sectional analyses of 6120 participants in the Sleep Heart Health Study, stratified by age: 40 to 59 (n=2477) and > or =60 years. Outcome measures included apnea-hypopnea index (AHI; average number of apneas plus hypopneas per hour of sleep), systolic/diastolic hypertension (> or =140 and > or =90 mm Hg), and ISH (> or =140 and <90 mm Hg). With adjustment for covariates, ISH was not associated with SDB in either age category. In those aged<60 years, AHI was significantly associated with higher odds of systolic/diastolic hypertension (AHI 15 to 29.9, OR=2.38 [95% CI 1.30 to 4.38]; AHI > or =30, OR=2.24 [95% CI 1.10 to 4.54]). Among those aged > or =60 years, no adjusted association between AHI and systolic/diastolic hypertension was found.
SDB is associated with systolic/diastolic hypertension in those aged <60 years. No association was found between SDB and systolic/diastolic hypertension in those aged > or =60 years or between SDB and ISH in either age category. These findings have implications for SDB screening and treatment. Distinguishing between hypertensive subtypes reveals a stronger association between SDB and hypertension for those aged <60 years than previously reported.

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    • "Furthermore, in a subanalysis72 of 3670 subjects not taking antihypertensive medication, AHI was positively associated with BP in a dose dependent manner. It is important, however, to highlight that the level of risk is somewhat weakened in older individuals to the point where a subsequent analysis revealed73 no association with hypertension for any AHI severity in subjects aged > 60 years. In contrast, significant associations were present for all levels of OSA in subjects aged between 40–59 years.73 "
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    ABSTRACT: Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.
    Nature and Science of Sleep 05/2013; 5:43-52. DOI:10.2147/NSS.S34841
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    • "The relationship between OSA and AF is complicated by the fact that obesity is also an independent predictor of AF. Furthermore, in patients with OSA who are under 50 years of age, there has been evidence to show that they are more likely to suffer hypertension, AF, and all-cause mortality [11, 43, 44]. "
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    ABSTRACT: In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient's risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation.
    Pulmonary Medicine 02/2013; 2013(12):621736. DOI:10.1155/2013/621736
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    • "SDB may cause nightly decreases in oxygen saturation (i.e., intermittent hypoxia) and increased sympathetic activity, which might contribute to cardiovascular stress [4] [5]. Large-scaled epidemiological studies have shown SDB to be independently associated with hypertension [6] [7] [8], as well as to heart failure (HF) and stroke [9]. A number of studies with samples recruited at sleep clinics or hospitals have also shown SDB to be an independent predictor of mortality [10– 14]. "
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    ABSTRACT: Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far. To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function. A prospective cohort design was used and 331 community dwelling elderly aged 71-87 years underwent one-night polygraphic recordings in the subjects' homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years. In the total population there were no significant associations between mortality and SDB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) ≥10 was associated with mortality. The hazard ratio of 3.0 (CI 95% 1.1-8.6, p=0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP. SDB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI ≥10) were associated with mortality in the group who had CVD in combination with impaired systolic function.
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