Sleep Apnea and Hypertension | Ten Points to Remember
- Torres G, Sánchez-de-la-Torre M, Barbé F.
- The Relationship Between Obstructive Sleep Apnea and Hypertension. Chest 2015;Apr 16:[Epub ahead of print].
The following are 10 points to remember about the relationship between obstructive sleep apnea (OSA) and hypertension:
- OSA is a common disease that is caused by a collapse of the upper airway during sleep, which leads to transient asphyxia.
- There is a bidirectional association between OSA and systemic hypertension, which appears to be modulated by factors such as age, sex, and somnolence.
- The 24-hour blood pressure (BP) circadian pattern also appears to be influenced by OSA. Patients with this syndrome exhibit a high prevalence of nondipping or riser circadian patterns, which are related to clinical and subclinical organ damage in the heart and brain.
- Based on contemporary data, it appears that OSA is an independent cause of hypertension, but with less significance than initially suspected.
- There is an epidemiological relationship between OSA and hypertension that is especially important in subjects with resistant hypertension.
- OSA may also lead to the development of an unfavorable circadian pattern of BP with worse cardiovascular outcomes.
- Several meta-analyses have demonstrated a concordant mild effect of continuous positive airway pressure (CPAP) on systemic hypertension. The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials.
- The effect of CPAP is more evident in patients with resistant hypertension (a decrease of approximately 6 mm Hg). Long-term randomized controlled trials are needed to clarify the role of CPAP treatment in the clinical management of resistant hypertension.
- Lifestyle modifications, including weight loss, should be recommended in OSA patients receiving hypertension treatment.
- Diuretics, particularly anti-aldosteronic diuretic agents, in the absence of additional data reported by clinical studies on other antihypertensive drug treatments, should be considered the first-line antihypertensive drug treatment in patients with OSA. By reducing para-pharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.
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