Obstructive Sleep Apnea and Hypertension: From Correlative to Causative Relationship

Sleep Laboratory, Faculty of Medicine,Technion-Israel Institute of Technology, Haifa, Israel.
Journal of Clinical Hypertension (Impact Factor: 2.85). 09/2001; 3(5):296-301. DOI: 10.1111/j.1524-6175.2001.00491.x
Source: PubMed


Sleep-disordered breathing, manifested by repetitive episodes of partial or complete cessation of breathing during sleep associated with brief arousal and autonomic activation, is estimated to affect as many as 4% of adult men and 2% of adult women. Studies conducted during the 1980s revealed a strong association between sleep-disordered breathing and hypertension. The results of these early studies, which relied on relatively small samples of patients, have been confirmed in recent years by large-scale epidemiologic studies that are controlled for all possible confounding factors. This paper reviews the evidence suggesting a causative relationship between hypertension and disordered breathing in sleep. The authors discuss the possible underlying mechanisms of the two entities and address the clinical implications of this relationship. They conclude by recommending a proactive approach to the diagnosis of breathing disorders in sleep, in order to prevent the cardiovascular sequelae of this syndrome.

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Available from: Peretz Lavie, Sep 16, 2014
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    • "Some found significant association between alcohol consumption and SA (6, 7), while others reported no association (8, 9). SA has been characterized as a chronic condition by high undiagnosed rate among adults as well as increasing linkage to premature death and illnesses including diabetes (10), cardiovascular disease (11, 12), obesity (12, 13), depression (14), and hypertension (15). However, the associations of SA with alcohol consumption and some chronic diseases has been inconsistent. "
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    ABSTRACT: Background:Sleep apnea (SA) is a common sleep disorder among US adults. Associations of SA with alcohol consumption and some chronic diseases have been inconsistent.Objectives:This study aimed to estimate prevalence of SA and examine its associations with potential factors including alcohol consumption, asthma, diabetes, and hypertension.Patients and Methods:This was a cross-sectional study on 823 adults with SA and 38,638 controls from the 2011 National Survey on Drug Use and Health Data. Weighted univariate and multiple logistic regression analyses were used to examine the associations of SA with the potential factors.Results:The prevalence of SA was higher in males (4.01%) than in females (2.61%), while the prevalence increased with age (0.86%, 3.50%, and 4.47% for age groups of 18-25, 26-64, and ≥ 65, respectively). Univariate analysis revealed that all factors except for income and education were associated with SA (P < 0.05). In multivariable analyses, participants who were current and past alcohol consumers had significantly higher odds of having SA (OR = 1.52, 95% CI = 1.03-2.23; OR = 1.65, 95% CI = 1.09-2.49, respectively) than non-alcohol drinker. Furthermore, asthma (OR = 2.77, 95% CI = 2.04-3.75), diabetes (OR = 2.89, 95% CI = 2.19-3.83), and hypertension (OR = 2.42, 95% CI = 1.91-3.07) were significantly associated with SA.Conclusions:Age, alcohol consumption, asthma, diabetes, and hypertension, were positively associated with SA. More efforts should be directed to promoting screening for SA and finding possible treatments for SA among these vulnerable groups.
    Full-text · Article · Jun 2014
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    • "In addition , some sleep disorders such as obstructive sleep apnea (OSA) are associated with partial sleep deprivation [3]. Moreover, OSA and most sleep deprivation occur during the paradoxical stage of sleep [4] [5]. Epidemiologic studies reported a U-shaped relationship between sleep duration and mortality by which it was concluded that both sleep excess and sleep deprivation are a threat to survival [6]. "
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    ABSTRACT: According to some reports regarding the increase of cardiac events following sleep deprivation, our study was conducted to clarify the effects of rapid eye movement (REM) sleep deprivation on susceptibility to lethal ventricular arrhythmias in rat. The animal groups included the control group; the sham 48 and sham 72 groups (without sleep deprivation); and the test 48 and test 72 groups, who experienced REM sleep deprivation for 48h and 72h, respectively. For induction of cardiac arrhythmia, aconitine was infused via the tail vein of the animals. After 72h of REM sleep deprivation, the blood pressure (BP) levels and the QTc interval of the electrocardiogram (ECG) were significantly increased (P<.05 and P<.01, respectively). However, the sleep deprivation had no significant effect on the heart rate (HR), myocardial oxygen consumption index, and plasma corticosterone level. Furthermore, sleep deprivation increased the latency times of premature ventricular contraction (PVC), ventricular tachycardia (VT), and also the PVC number; however, it did not increase the number, duration, and severity of VT and ventricular fibrillation (VF). Our findings suggest that 72h of REM sleep deprivation is associated with increased risk for hypertension and QT interval prolongation under nonstressful conditions; however, it does not increase the susceptibility to lethal ventricular arrhythmia in rat.
    Full-text · Article · Sep 2013 · Sleep Medicine
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    • "Due to this self-enforced sleep restriction, most deprivation occurs in the paradoxical stage that predominantly emerges during the last half of the night's sleep [3]. Moreover, some sleep disorders that result in partial sleep deprivation, such as obstructive sleep apnea (OSA) [4], occur mainly during paradoxical sleep (PS) [5]. Many theories postulate that paradoxical sleep (PS) may have a key role in learning and memory processes (for review see [6] [7]). "
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    ABSTRACT: Paradoxical sleep deprivation (PSD) may alter subsequent learning and memory capacity. There are differences in both the intensity and direction of responses of the male and female species to the same environmental stimuli and experimental conditions. In the present study, we examined the extent of the effects of PSD for 72h on spatial learning and memory, anxiety-like behavior, corticosterone levels, and the body weight in male as well as in intact and ovariectomized (OVX) female Wistar rats. Multiple platform method was used for PSD induction. Spatial learning and memory and anxiety-like behavior were determined using Morris water maze (MWM) task and open field test, respectively. The data showed that PSD could not significantly affect subsequent spatial learning and short-term memory in male rats, while it significantly impaired the performance of the intact and OVX female rats. The PSD-intact and -OVX female rats showed more memory impairment than the PSD-male animals. Those impairments do not appear to be due to elevated stress level, since the plasma corticosterone did not significantly change following PSD induction. The open field data showed that PSD significantly reduced anxiety-like behavior in all experimental groups. In addition, PSD had a reducing effect on the mean body weight of female groups. Such results suggest that the female rats are more vulnerable to the deleterious effects of sleep loss on cognitive performance.
    Full-text · Article · Dec 2011 · Behavioural brain research
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