Esther Sapiña-Beltrán1,2, Gerard Torres1, Ivan Benitez1, Ana Maria Fortuna-Gutiérrez2,3, Paola Ponte Márquez4, Juan Fernando Masa2,5, Jaime Corral-Peñafiel2,5, Luciano F Drager6, Mayara Cabrini6, Miguel Félez7, Susana Vázquez8, Jorge Abad2,9, Chi-Hang Lee10, Aye Thandar Aung10, Francisco García-Río2,11, Raquel Casitas2,11, Manuel Sanchez-de-la-Torre1,2, Anna Michela Gaeta1, Ferran Barbé1,2, Mireia Dalmases1,2. 1. Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Lleida, Catalunya, Spain. 2. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain. 3. Sleep Unit, Respiratory Department, and. 4. Internal Medicine, Emergency Department, Hypertension and Cardiovascular Risk Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autónoma de Barcelona, Bellaterra, Catalunya, Spain. 5. Respiratory Department, Hospital San Pedro de Alcantara, Cáceres, Extremadura, Spain. 6. Hypertension Unit, Renal Division, University of Sao Paulo Medical School, São Paulo, Brazil. 7. Unit of Sleep Breathing Disorders, Respiratory Department and. 8. Hypertension and Vascular Risk Unit, Nephrology Department, Hospital del Mar, Parc de Salut Mar, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona-Universitat Pompeu Fabra, Barcelona, Catalunya, Spain. 9. Respiratory Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain. 10. Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore; and. 11. Respiratory Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain.
Abstract
Rationale: Obstructive sleep apnea (OSA) is associated with poor blood pressure (BP) control and resistant hypertension (RH). Nevertheless, studies assessing its prevalence, characteristics, and association with BP control in patients with RH are limited. Objectives: The aim of this multicenter study was to assess the prevalence of OSA in a large cohort of subjects with RH and to evaluate the association of OSA with BP control. Methods: We recruited consecutive subjects with RH from three countries. A formal sleep test and blood pressure measurements, including 24-hour ambulatory blood pressure monitoring, were performed in all participants. Results: In total, 284 subjects with RH were included in the final analysis. Of these, 83.5% (95% confidence interval [CI], 78.7-87.3%) had OSA (apnea-hypopnea index ≥ 5 events/h); 31.7% (95% CI, 26.5-37.3%) had mild OSA, 25.7% (95% CI, 21-31.1%) had moderate OSA, and 26.1% (95% CI, 21.3-31.5%) had severe OSA. Patients with severe OSA had higher BP values than subjects with mild to moderate or no OSA. A greater effect was observed on the average nighttime BP, with an adjusted effect of 5.72 mm Hg (95% CI, 1.08-10.35 mm Hg) in severe OSA compared with participants without OSA. A dose-response association between the severity of OSA and BP values was observed. The prevalence of severe OSA was slightly higher in uncontrolled participants (adjusted odds ratio, 1.69; 95% CI, 0.97-2.99) but was not statistically significant.Conclusions: The present study confirms the high prevalence of OSA in participants with RH. Furthermore, it shows a dose-response association between OSA severity and BP measurements, especially in the nighttime.Clinical trial registered with www.clinicaltrials.gov (NCT03002558).
Rationale: Obstructive sleep apnea (OSA) is associated with poor blood pressure (BP) control and resistant hypertension (RH). Nevertheless, studies assessing its prevalence, characteristics, and association with BP control in patients with RH are limited. Objectives: The aim of this multicenter study was to assess the prevalence of OSA in a large cohort of subjects with RH and to evaluate the association of OSA with BP control. Methods: We recruited consecutive subjects with RH from three countries. A formal sleep test and blood pressure measurements, including 24-hour ambulatory blood pressure monitoring, were performed in all participants. Results: In total, 284 subjects with RH were included in the final analysis. Of these, 83.5% (95% confidence interval [CI], 78.7-87.3%) had OSA (apnea-hypopnea index ≥ 5 events/h); 31.7% (95% CI, 26.5-37.3%) had mild OSA, 25.7% (95% CI, 21-31.1%) had moderate OSA, and 26.1% (95% CI, 21.3-31.5%) had severe OSA. Patients with severe OSA had higher BP values than subjects with mild to moderate or no OSA. A greater effect was observed on the average nighttime BP, with an adjusted effect of 5.72 mm Hg (95% CI, 1.08-10.35 mm Hg) in severe OSA compared with participants without OSA. A dose-response association between the severity of OSA and BP values was observed. The prevalence of severe OSA was slightly higher in uncontrolled participants (adjusted odds ratio, 1.69; 95% CI, 0.97-2.99) but was not statistically significant.Conclusions: The present study confirms the high prevalence of OSA in participants with RH. Furthermore, it shows a dose-response association between OSA severity and BP measurements, especially in the nighttime.Clinical trial registered with www.clinicaltrials.gov (NCT03002558).
Authors: Demetrio Gonzalez-Vergara; Sergio Marquez-Pelaez; Jose David Alfonso-Arias; Julia Perez-Ramos; Jose Luis Rojas-Box; Manuel Aumesquet-Nosea Journal: BMC Health Serv Res Date: 2021-05-18 Impact factor: 2.655