Polysomnographic Profile of Hypertensive Patients with Sleep Related Breathing Disorders-An Observational Study
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 9
Abstract
Background: Obstructive Sleep Apnea [OSA] is now well recognised as an independent risk factor for Hypertension. Still there is a paucity of research in identifying the predictors of Hypertension in patients with sleep-related breathing disorders. This study is undertaken in this context to look into the clinical profile of hypertensive patients with OSA and to see how it differed from normotensive patients with OSA. Materials and Methods: A total of 85 subjects were included in the study. Symptoms suggestive of OSA were sought in a structured interview. They were asked to fill up the Epworth sleepiness scale questionnaire in the presence of their partner. Patients were grouped as Hypertensive if they are diagnosed Hypertension based on blood pressure or if they are currently taking antihypertensive medications. The patients who did not belong to the above category were grouped as Normotensives.. A complete physical examination and anthropometry followed by overnight polysomnography (OPS) were done in all patients. Apnea-Hypopnea index of >15 is taken as clinically significant suggestive of moderate to severe OSA. Statistical analysis was done using SPSS statistical software. Sethu Babu et al JMSCR Volume 2 Issue 9 September 2014 Page 2285 JMSCR Volume||2||Issue||9||Page 2284-2292||September-2014 2014 INTRODUCTION Sleep-related breathing disorders [SBD] have emerged as a major global public health burden. It is characterised by repeated events of ever increasing resistance to airflow in the upper airway. The spectrum of SBD includes primary snoring, Upper airway resistance syndrome, Sleep hypopnea syndrome, Obstructive sleep apnea [OSA] syndrome and obesity hypoventilation syndrome. Of these, obstructive sleep apnea syndrome is the most severe form having considerable impact on individual’s health. Obstructive sleep apnea has been strongly implicated in the initiation and progression of cardiovascular diseases. The interrelation between OSA and Hypertension remains still under explored. There is a high prevalence of hypertension in OSA patients as well as high levels of OSA in hypertensive cohorts. The available evidences now suggest that OSA is casually related to the development of Hypertension as an independent risk factor. It is also observed that 70% of patients with refractory hypertension have underlying sleep related breathing disorder [1]. The normal nocturnal dipping pattern of blood pressure is blunted or lost in patients with OSA. The current evidence also suggest that treatment of OSA with CPAP results in decrease in 24-hour mean and diastolic pressure and an improvement in nocturnal blood pressure pattern[2]. Interestingly, recent evidence also points towards an inverse relationship that OSA can be aggravated through increase in pharyngeal resistance induced by co-existing hypertension [3]. The exact pathophysiological mechanism contributing the development of Hypertension in OSA patients is unclear but it is postulated that repeated episodes of obstructive apnea result in nocturnal hypoxemia and CO2 retention which trigger chemoreflex activation resulting in increased peripheral sympathetic activity causing vasoconstriction and surges in arterial blood pressure [4, 5]. These nocturnal metabolic, pressor and reflex responses are carried over to daytime also via mediators like plasma endothelins [6]. Additionally it is also found that OSA is linked to vascular endothelial dysfunction, oxidative stress, vascular remodelling, hypercoagulability and stimulation of rennin angiotensin system resulting in cardiovascular consequences [7, 8, 9,10,11]. Results: Average age of hypertensive patients with OSA was at a higher level than that of normotensive patients with OSA. There was a high proportion of hypertension in patients with clinically significant OSA [AHI>15] compared to those with mild OSA or primary snoring. Conclusions: We may conclude that OSA patients with AHI > 15 have 2.85 times risk of hypertension when compared to patients with mild OSA. Also age is the most meaningful factor in predicting the development of hypertension in these patients with moderate to severe OSA.
Authors and Affiliations
Dr Sethu Babu
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