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Sleep Apnea and Hypertension: A Population-based Study

Khin Mae Hla, MD, MHS; Terry B. Young, PhD; Tom Bidwell, MS; Mari Palta, PhD; James B. Skatrud, MD; and Jerome Dempsey, PhD
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From the University of Wisconsin School of Medicine, Madison, Wisconsin. Requests for Reprints: Khin Mae Hla, MD, MHS, Department of Medicine, University of Wisconsin, Clinical Science Center, J5/210, 600 Highland Avenue, Madison, WI, 53792. Acknowledgments: The authors thank Claire Falk, Julie Dohr, and Ann Andre for technical assistance. Grant Support: By National Institutes of Health grant PO1 HL 42242 and by grant RR 03186 from the Department of Veterans Affairs Medical Research Service.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(5):382-388. doi:10.7326/0003-4819-120-5-199403010-00005
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Objective: To measure the independent association of sleep-disordered breathing (sleep apnea and habitual snoring) and hypertension in a healthy adult population.

Design: A cross-sectional study of blood pressure during wakefulness and sleep among participants with and without sleep-disordered breathing.

Setting: Community-based study.

Participants: 147 men and women, aged 30 to 60 years, selected from Wisconsin State employees enrolled in the Wisconsin Sleep Cohort Study, an ongoing, prospective, epidemiologic study of sleep-disordered breathing.

Measurements: Sleep and medical history interview, nocturnal polysomnography, and 24-hour ambulatory blood pressure monitoring in all participants.

Results: Mean blood pressures were significantly higher among participants with sleep apnea (≥ 5 apneas or hypopneas per hour of sleep) compared with those without (131/80 ±1.7/1.1 mm Hg compared with 122/75 ±1.9/1.2 mm Hg during wakefulness and 113/66 ±1.8/1.1 mm Hg compared with 104/62 ±2/1.3 mm Hg during sleep, respectively; P < 0.05). The variability of the blood pressure during sleep was significantly greater in participants with sleep apnea or a history of snoring compared with those without (P < 0.05). After controlling for obesity, age, and sex, sleep apnea was significantly associated with hypertension in a dose-response fashion, with odds ratios ranging from 2.0 for 5 apneic or hypopneic episodes per hour of sleep to 5.0 for 25 apneic or hypopneic episodes.

Conclusions: Our data indicate an association between hypertension and sleep apnea independent of obesity, age, and sex in a nonselected, community-based adult population.


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Figure 1.
Temporal plots of the average mean arterial pressures according to sleep-disordered breathing status.n

Mean arterial pressures (MAPs) of all participants ( = 147) averaged at each hour during the hours before bedtime, at bedtime, and after bedtime. AHI = apnea–hypopnea index (number of episodes of apnea and hypopnea per hour of sleep).

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Figure 2.
Prevalence of hypertension among participants with and without sleep-disordered breathing stratified by obesity, sex, and age.2

Frequency distribution of hypertension in participants with sleep-disordered breathing (apnea–hypopnea index ≥ 5 as indicated by open bars, snorers with an apnea–hypopnea index < 5 as indicated by hatched bars) and without sleep-disordered breathing (nonsnorers with an apnea–hypopnea index < 5 as indicated by shaded bars). BMI = body mass index measured in kg/m .

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