Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep

• Published in: Chest Vol. 150; no. 3; p. 495
• Main Authors: Appleton, Sarah L, Vakulin, Andrew, Martin, Sean A, Lang, Carol J, Wittert, Gary A, Taylor, Anne W, McEvoy, R Doug, Antic, Nick A, Catcheside, Peter G, Adams, Robert J
• Format: Journal Article
• Language: English
• Published: United States 01.09.2016
• Subjects: Adult; Aged; Cross-Sectional Studies; Humans; Hypertension - epidemiology; Longitudinal Studies; Male; Middle Aged; Polysomnography; Prevalence; Risk Factors; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep, REM; South Australia - epidemiology; obstructive sleep apnea; epidemiology; hypertension; rapid eye movement sleep; men
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2016.03.010

Evidence linking OSA with hypertension in population studies is conflicting. We examined longitudinal and cross-sectional associations of previously unrecognized OSA, including OSA occurring in rapid eye movement (REM) sleep, with hypertension. The Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study is a longitudinal study of community-dwelling men in Adelaide, South Australia. Biomedical assessments at baseline (2002-2006) and follow-up (2007-2010) identified hypertension (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg, or medication) and risk factors. In 2010 to 2011, 837 men without a prior diagnosis of OSA underwent full in-home unattended polysomnography of whom 739 recorded ≥ 30 min of REM sleep. Hypertension at follow-up (concomitant with OSA status) was defined as prevalent hypertension. Recent-onset hypertension was defined as hypertension at biomedical follow-up (56 months mean follow-up [range, 48-74]) in men free of hypertension at baseline. Severe REM OSA (apnea hypopnea index ≥30/h) showed independent adjusted associations with prevalent (OR, 2.40, 95% CI, 1.42-4.06), and recent-onset hypertension (2.24 [1.04-4.81]). Significant associations with non-REM AHI were not seen. In men with AHI < 10, REM OSA (apnea hypopnea index) ≥ 20/h was significantly associated with prevalent hypertension (2.67 [1.33-5.38]) and the relationship with recent-onset hypertension was positive but not statistically significant (2.32 [0.79-6.84]). Similar results were seen when analyses were confined to men with non-REM AHI < 10. In men not considered to have OSA (AHI < 10), hypertension was associated with OSA during REM sleep. REM OSA may need consideration as an important clinical entity requiring treatment but further systematic assessment and evidence is needed.