Prospective Study of Sleep-disordered Breathing and Hypertension

Pulmonary Center, Boston University School of Medicine, 715 Albany St., Boston, MA 02118, USA.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 04/2009; 179(12):1159-64. DOI: 10.1164/rccm.200712-1809OC
Source: PubMed


Cross-sectional epidemiologic studies show an association between sleep-disordered breathing and hypertension, but only one cohort study has examined sleep-disordered breathing as a risk factor for incident hypertension.
To examine whether sleep-disordered breathing increases the risk of incident hypertension among persons 40 years of age and older.
In a prospective cohort study, we analyzed data from 2,470 participants who at baseline did not have hypertension, defined as blood pressure of at least 140/90 mm Hg or taking antihypertensive medication. The apnea-hypopnea index (AHI), the number of apneas plus hypopneas per hour of sleep, was measured by overnight in-home polysomnography. We estimated odds ratios for developing hypertension during 5 years of follow-up according to baseline AHI.
The odds ratios for incident hypertension increased with increasing baseline AHI; however, this relationship was attenuated and not statistically significant after adjustment for baseline body-mass index. Although not statistically significant, the observed association between a baseline AHI greater than 30 and future hypertension (odds ratio, 1.51; 95% confidence interval, 0.93-2.47) does not exclude the possibility of a modest association.
Among middle-aged and older persons without hypertension, much of the relationship between AHI and risk of incident hypertension was accounted for by obesity. After adjustment for body mass index, the AHI was not a significant predictor of future hypertension, although a modest influence of an AHI greater than 30 on hypertension could not be excluded.

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Available from: Stuart F Quan, Jun 11, 2014
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    • "OSA appears to be related to several cardiovascular diseases, even after adjustment for confounding variables. These diseases include systemic hypertension [1]; pulmonary hypertension, particularly in cases of comorbid daytime hypoxemia [2] [3] [4] [5] [6]; coronary artery disease (CAD) [7] [8] [9]; heart failure [9]; and nocturnal cardiac arrhythmia [10] [11] [12]. "
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    ABSTRACT: Background: Despite the association between obstructive sleep apnea (OSA) and coronary artery disease (CAD), few studies have investigated this issue in Saudi Arabia. Objectives: This study aimed to identify the prevalence of OSA among CAD patients. Subjects and methods: This was a cross-sectional (descriptive) study conducted at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia from April 2012 to December 2013. All consecutive patients referred to the cardiac catheterization lab for coronary angiography who exhibited evidence of CAD were included in this study. This study was conducted in two stages. During the first stage, each participant was interviewed individually. The administered interview collected data pertaining to demographics, comorbidities, and the STOP-BANG questionnaire score. The second stage of this study consisted of a diagnostic overnight polysomnography (PSG) of 50% of the subjects at high risk for OSA according to the STOP-BANG questionnaire. Results: Among the patients with CAD (N = 156), 128 (82%) were categorized as high risk for developing OSA. PSG was conducted on 48 patients. The estimated prevalence of OSA in the study sample was 56.4%. Approximately 61% of the documented sleep apnea patients suffered from moderate to severe OSA. Conclusion: This local study concurs with reports in the literature indicating that OSA is very common among CAD patients.
    Full-text · Article · Mar 2015 · Journal of the Saudi Heart Association
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    • "The American Sleep Disorder Association (The Report of an American Academy of Sleep Medicine Task Force, 1999) categorized OSA on the basis of the AHI, as follows: normal sleep, AHI< 5; mild OSA, AHI 5-15; moderate OSA, AHI 15-30; severe OSA, AHI >30. OSA, especially severe OSA, has been associated with cardiovascular morbidity (Marin et al., 2005), systemic hypertension (Young et al., 2002, O&apos;Connor et al., 2009), cerebrovascular disorders (Gibson, 2004), and depression (Baran & Richert, 2003). Patients may report a considerable reduction in overall quality of life (Phillips et al., 2013). "
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    ABSTRACT: Objective Oral appliances for treating severe obstructive sleep apnea are recommended for patients who failed to comply with continuous positive airway pressure treatment. The objective of this study was to evaluate medium-long-term outcome and success rates of oral appliances in patients with severe obstructive sleep apnea.MethodsA retrospective study including 52 obstructive sleep apnea patients with an apnea-hypopnea index ≥ 40, who did not tolerate continuous positive airway pressure treatment, were enrolled and fitted with a modified Herbst oral appliance. A two year mean follow-up including a second somnography was conducted in 36 of the patients.ResultsA significant reduction (P<0.0001) in the apnea-hypopnea index was demonstrated between the initial somnography (55.25±10.79,) and the followed one (17.74±11.0, n=36). Overall, 57.7% of total study subjects (n=52) and 63.9% (n=36) that had sequential sonmogarphy continued using the device. The reduction in apnea-hypopnea index in the user group was 42.4±3.1 (n=23), which was significantly higher (P=0.013) than in the non-user group (28.9±17.2; n=13). Moreover, 53% (n=19) reached apnea-hypopnea index of less than 15.Conclusions Oral appliances were found to be successful for treating for severe obstructive sleep apnea after first-line treatment had failed.This article is protected by copyright. All rights reserved.
    Full-text · Article · Sep 2014 · Oral Diseases
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    • "However, the results were not consistent. In another cohort study, although a significant relationship between hypertension and OSA was identified, the association was diminished after controlling the BMI (36). Results from Victoria sleep cohort study found no association between OSA and incident systemic hypertension in middle-aged adults (37). "
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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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