Khaled Abdel-Kader1, Sheena Dohar2, Nirav Shah1, Manisha Jhamb1, Steven E Reis3, Patrick Strollo4, Daniel Buysse5, Mark L Unruh1. 1. Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA. 2. West Virginia University School of Medicine, Morgantown, WV. 3. Division of Cardiology, University of Pittsburgh, Pittsburgh PA. 4. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 5. Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD). METHODS: We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90 mmHg despite at least three antihypertensive drugs. RESULTS: Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2 mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix. CONCLUSION: The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.
OBJECTIVES: To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD). METHODS: We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRDparticipants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90 mmHg despite at least three antihypertensive drugs. RESULTS: Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2 mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix. CONCLUSION: The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.
Authors: Carolina C Gonzaga; Krishna K Gaddam; Mustafa I Ahmed; Eduardo Pimenta; S Justin Thomas; Susan M Harding; Suzanne Oparil; Stacey S Cofield; David A Calhoun Journal: J Clin Sleep Med Date: 2010-08-15 Impact factor: 4.062
Authors: A Di Murro; L Petramala; D Cotesta; L Zinnamosca; E Crescenzi; C Marinelli; M Saponara; C Letizia Journal: J Renin Angiotensin Aldosterone Syst Date: 2010-05-20 Impact factor: 1.636
Authors: Oded Friedman; T Douglas Bradley; Christopher T Chan; Robert Parkes; Alexander G Logan Journal: Hypertension Date: 2010-11-08 Impact factor: 10.190
Authors: K Gaddam; E Pimenta; S J Thomas; S S Cofield; S Oparil; S M Harding; D A Calhoun Journal: J Hum Hypertens Date: 2009-12-17 Impact factor: 3.012
Authors: Jennifer N Miller; Paula Schulz; Bunny Pozehl; Douglas Fiedler; Alissa Fial; Ann M Berger Journal: Sleep Breath Date: 2017-11-14 Impact factor: 2.816
Authors: Branko Braam; Sandra J Taler; Mahboob Rahman; Jennifer A Fillaus; Barbara A Greco; John P Forman; Efrain Reisin; Debbie L Cohen; Mohammad G Saklayen; S Susan Hedayati Journal: Clin J Am Soc Nephrol Date: 2016-11-28 Impact factor: 8.237
Authors: Rikki M Tanner; David A Calhoun; Emmy K Bell; C Barrett Bowling; Orlando M Gutiérrez; Marguerite R Irvin; Daniel T Lackland; Suzanne Oparil; William McClellan; David G Warnock; Paul Muntner Journal: Am J Kidney Dis Date: 2014-01-01 Impact factor: 8.860
Authors: Rikki M Tanner; David A Calhoun; Emmy K Bell; C Barrett Bowling; Orlando M Gutiérrez; Marguerite R Irvin; Daniel T Lackland; Suzanne Oparil; David Warnock; Paul Muntner Journal: Clin J Am Soc Nephrol Date: 2013-07-18 Impact factor: 8.237