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:

  1. OSA is a common disease that is caused by a collapse of the upper airway during sleep, which leads to transient asphyxia.
  2. There is a bidirectional association between OSA and systemic hypertension, which appears to be modulated by factors such as age, sex, and somnolence.
  3. 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.
  4. Based on contemporary data, it appears that OSA is an independent cause of hypertension, but with less significance than initially suspected.
  5. There is an epidemiological relationship between OSA and hypertension that is especially important in subjects with resistant hypertension.
  6. OSA may also lead to the development of an unfavorable circadian pattern of BP with worse cardiovascular outcomes.
  7. 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.
  8. 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.
  9. Lifestyle modifications, including weight loss, should be recommended in OSA patients receiving hypertension treatment.
  10. 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.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension, Sleep Apnea

Keywords: Airway Obstruction, Antidiuretic Agents, Antihypertensive Agents, Asphyxia, Blood Pressure, Continuous Positive Airway Pressure, Diuretics, Edema, Hypertension, Life Style, Metabolic Syndrome X, Prevalence, Primary Prevention, Sleep, Sleep Apnea, Obstructive, Sleep Stages, Weight Loss

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