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Sleep apnea syndrome: a possible contributing factor to resistant
1Sleep Laboratory, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa. plavie@tx.technion.ac.il
Sleep
|September 19, 2001
Summary
Patients with sleep apnea and hypertension who respond well to medication have less severe sleep apnea. More severe sleep apnea is linked to ineffective blood pressure control, suggesting sympathetic stimulation may cause resistant hypertension.
Area of Science:
- Cardiology
- Sleep Medicine
- Pharmacotherapy
Background:
- Sleep apnea is associated with hypertension.
- The impact of sleep apnea on hypertension pharmacotherapy is not well understood.
Purpose of the Study:
- To investigate the relationship between sleep apnea severity and the effectiveness of anti-hypertensive treatment.
Main Methods:
- Analyzed 1,485 adult patients with sleep apnea (apnea/hypopnea index >10 events/hr).
- Compared 183 effectively treated patients (BP <140/90 mmHg) with 74 ineffectively treated patients (BP >140/90 mmHg).
- Used analysis of covariance, adjusting for gender, age, BMI, and neck circumference.
Main Results:
- Ineffectively treated patients had a significantly higher apnea/hypopnea index (44 vs. 33 events/hr, p<.0005).
- Age, BMI, and nocturnal oxygenation were similar between groups.
- The difference in apnea/hypopnea index persisted after adjusting for covariates.
Conclusions:
- Hypertensive patients with sleep apnea who respond to treatment have less severe sleep apnea.
- Obesity and nocturnal hypoxemia do not appear to be primary drivers of ineffective treatment.
- Resistant hypertension in sleep apnea may be linked to intermittent sympathetic nervous system activation.