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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    • "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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    • "Earlier studies have reported a positive association between SDB and hypertension in the elderly (Stoohs et al. 1996). The Sleep Heart Health Study (Haas et al. 2005), has provided some additional insight, although they found no association between SDB and systolic/ diastolic hypertension in those aged ≥60 years. They did report a positive association between the severity of SDB (based on overnight polysomnography) and the risk of developing cardiovascular disease including coronary artery disease and stroke (Shahar et al. 2001). "
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