Yonsei Med J.  2015 Sep;56(5):1258-1265. 10.3349/ymj.2015.56.5.1258.

Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

• Min HJ
• Cho YJ
• Kim CH
• Kim DH
• Kim HY
• Choi JI
• Lee JG
• Park S
• Cho HJ

• KMID: 2163617
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1258

Abstract

PURPOSE
Resistant hypertension (HTN) occurs in 15-20% of treated hypertensive patients, and 70-80% of resistant hypertensive patients have obstructive sleep apnea (OSA). The characteristics of resistant HTN that predispose patients to OSA have not been reported. Therefore, we aimed to determine the clinical, laboratory, and polysomnographic features of resistant HTN that are significantly associated with OSA.
MATERIALS AND METHODS
Hypertensive patients (n=475) who underwent portable polysomnography were enrolled. The patients were categorized into controlled (n=410) and resistant HTN (n=65) groups. The risk factors for the occurrence of OSA in controlled and resistant hypertensive patients were compared, and independent risk factors that are associated with OSA were analyzed.
RESULTS
Out of 475 patients, 359 (75.6%) were diagnosed with OSA. The prevalence of OSA in resistant HTN was 87.7%, which was significantly higher than that in controlled HTN (73.7%). Age, body mass index, neck circumference, waist circumference, and hip circumference were significantly higher in OSA. However, stepwise multivariate analyses revealed that resistant HTN was not an independent risk factor of OSA.
CONCLUSION
The higher prevalence and severity of OSA in resistant HTN may be due to the association of risk factors that are common to both conditions.

Keyword

Resistant hypertension; sleep apnea; polysomnography; obesity; body mass index

MeSH Terms

Adult
Aged
Body Mass Index
Female
Humans
Hypertension/complications/*epidemiology
Male
Middle Aged
Polysomnography
Prevalence
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Sleep Apnea, Obstructive/complications/*epidemiology
Waist Circumference

Figure

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  Fig. 1 Flowchart of patients. Hypertensive patients were asked to perform the sleep study (including polysomnography, sleep questionnaires, laboratory tests, and anthropometric measurements), and 475 patients with complete data were enrolled in this retrospective study.

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  Fig. 2 Severity of OSA in HTN. The apnea-hypopnea index (AHI) was used to determine the prevalence and severity of OSA in controlled and resistant hypertensive patients. (A) The prevalence of OSA in controlled, resistant, and total hypertensive patients was compared. (B) The average AHIs of non-OSA, mild, moderate, and severe degrees of OSA are represented as mean±standard deviation in the controlled and resistant HTN groups. (C) The percentages of patients with non-OSA, mild, moderate, and severe OSA were compared between the controlled and resistant HTN groups (*p<0.05). OSA, obstructive sleep apnea; HTN, hypertension.

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