Comorbidities that modulate temporal risk for incident hypertension among patients with obstructive sleep apnea

Our study investigates the temporality of factors that modulate the risk for developing hypertension (HTN) among patients with obstructive sleep apnea (OSA) without preexisting HTN at baseline.

Our cohort consisted of OSA cases (based on International Classification of Diseases, 9th/10th Revision) with 20 common comorbidities selected using a previously validated electronic health record (EHR)-based algorithm. We constructed a survival model to estimate time-to-first HTN diagnosis (among patients with OSA without preexisting HTN). Our survival model included those comorbidities along with sex, body mass index, race, and age. We also performed a validation of the date of diagnosis of OSA and HTN identified from our algorithm by utilizing chart reviews in 400 randomly chosen EHR-defined cases.

Among 53,035 OSA cases diagnosed between 2012 and 2021, 31,741 cases (59.8%) were without preexisting HTN at the date of OSA diagnosis and thus met our inclusion criteria. Within our survival cohort, 15,830 OSA cases (50.1%) did not develop HTN. Cardiovascular conditions (including atrial fibrillation, coronary atherosclerosis, hypercholesterolemia, diabetes), tobacco use, anemia, osteoarthrosis, and gastroesophageal reflux disease were observed to increase risk of incident HTN. Allergic rhinitis, fatigue, joint pain, and vitamin D deficiency did not increase risk of incident HTN. Chart review demonstrated diagnoses of OSA and HTN were documented in notes a median of 38 days and 738 days, respectively, prior to being coded in the EHR.

In a large EHR sample, we identified conditions that are associated with increased risk of incident HTN among patients diagnosed with OSA. These findings may help guide counseling efforts among patients newly diagnosed with OSA regarding factors that may modulate risk for developing HTN.