Elevated blood pressure (BP) is seen among individuals with obstructive sleep apnea (OSA) who experience difficulty initiating and/or maintaining sleep (DIMS), compared with those with OSA alone, according to study results presented at the 2023 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 3 to 7 in Indianapolis, Indiana.
DIMS, which is associated with worse quality of life and mental health, is experienced by approximately 30% and 50% of individuals with OSA and sleep disturbances, compared with those with OSA alone. For the study, researchers sought to evaluate the possible associations between OSA and regular sleep disturbances with hypertension/blood pressure.
A total of 12,287 participants used a validated under-mattress sleep analyzer, “Withings”, to monitor sleep over approximately 6 months in their homes. During this time period, participants’ mean apnea-hypopnea index (AHI), sleep onset latency (SOL), and wake after sleep onset (WASO) were measured. The study used the following definitions:
- OSA: average AHI of ≥15 events per minute
- DIMS: average SOL of ≥30 minutes and/or WASO of ≥45 minutes
Participants were categorized into 1 of 4 groups:
- Those with neither condition (control group)
- OSA-alone group
- DIMS-alone group
- OAS-plus-DIMS group
A home monitor was utilized to measure participants’ BP. Hypertension was defined as a mean systolic BP (SBP) of ≥140 mm Hg and/or a mean diastolic BP (DBP) of ≥90 mm Hg. Regression analyses were used to examine the associations between OSA plus DIMS and hypertension, controlling for sex, age, and body mass index (BMI).
The mean participant age was 50±12 years. Overall, 88% of the individuals were men; the average BMI was 28±6 kg/m2, which was considered overweight. The prevalence of patients reported in each of the groups was 21% in the OSA-alone group, 10% in the
DIMS-alone group, and 8% in the OA-plus-DIMS group.
Compared with the control group, OSA-alone was associated with a mean 4.5 mm Hg (95% CI, 4.1-5.0 mm Hg) higher SBP value and a mean 2.6 mm Hg (95% CI, 2.3-2.93 mm Hg) higher DBP value.
Further, compared with the control group, OSA plus DIMS was associated with 5.9 mm Hg (95% CI, 5.3-6.6 mm Hg) difference in SBP and a 3.7 mm Hg (95% CI, 3.3-4.2 mm Hg) difference in DBP. This increased difference was greater than that observed in the OSA-alone group (SBP, +1.4 mm Hg [95% CI, 0.8-2.0 mm Hg]; DBP, +1.12 mm Hg [95% CI, 0.7-1.6 mm Hg]; P <.001).
In addition, compared with the control group, OSA-alone and OSA plus DIMS were associated with a 37% (95% CI, 22%-54%) and a 60% (95% CI, 36%-88%) increase in prevalence of hypertension, respectively. Moreover, participants in the OSA-plus-DIMS group vs those in the OSA-alone group had a greater increase in the prevalence of hypertension (17% [95% CI, –1% to 38%]).
“OSA when combined with difficulties initiating and maintaining sleep, consistent with insomnia symptomology, was associated with higher blood pressure and increased hypertension prevalence compared to OSA-alone,” the researchers concluded.
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Lechat B, Scott H, Sweetman A, Escourrou P, Eckert D. Difficulty initiating and maintaining sleep is associated with increased blood pressure in people with obstructive sleep apnea. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0465.