Association Between Severe Obstructive Sleep Apnea and Incident Arterial Hypertension in the Older People Population

Study Questions:

Is there a link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects?

Methods:

Data were obtained from the PROOF study, a longitudinal population-based cohort of 1,011 French volunteers ages 65 ± 1 years (61% women). Subjects were enrolled in the study in 2001 and assessed by at-home sleep study during a 7-year follow-up. Exclusion criteria were: myocardial infarction, heart failure, stroke, pacemaker therapy, previously diagnosed or treated OSA, diabetes mellitus (DM) type 1, and neurologic disorders. Severe OSA was defined by an apnea–hypopnea index (AHI) of ≥30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140 mm Hg for systolic blood pressure and >85 mm Hg for diastolic blood pressure or the use of antihypertensive medication.

Results:

The cohort included 372 normotensive subjects with a mean age of 68.2 years. Clinical characteristics were similar among the normotensive (n = 299) and new-onset hypertension groups (n = 73). According to univariate logistic regression analyses, the presence of an AHI ≥30 per hour was significantly associated with an increased risk for hypertension (p = 0.02). Other variables considered to be significantly associated with an increased risk for new-onset hypertension were male gender, obesity (body mass index, ≥30 kg/m2), DM type 2, or dyslipidemia. Multiple logistic regression analyses showed that an AHI ≥30 per hour was independently associated with incident hypertension after 3 years (p = 0.02; odds ratio, 1.8; 95% confidence interval, 1.1-2.8).

Conclusions:

The authors concluded that the presence of severe OSA is associated with new-onset hypertension in normotensive elderly subjects.

Perspective:

The majority of reports on the link between OSA and hypertension have been among middle-aged patients. These results suggest treating older individuals with severe OSA to prevent cardiovascular consequences and screening for OSA in hypertensive older adults. The results could not be explained by a change in AHI over study period nor by body mass index, since there were very few obese study subjects. Last, mild to moderate levels of OSA were not associated with hypertension, consistent with other published work, which found a low impact on cardiovascular morbidity in this age group of mild to moderate OSA.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Hypertension, Sleep Apnea

Keywords: Stroke, Myocardial Infarction, Follow-Up Studies, Blood Pressure, Sleep Apnea Syndromes, Dyslipidemias, Body Composition, Body Mass Index, Polysomnography, Obesity, Hypertension, Sleep Apnea, Obstructive, Diabetes Mellitus


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