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. 2010 Aug;138(2):434-43.
doi: 10.1378/chest.09-2954.

Sleep and hypertension

David A Calhoun  1 , Susan M Harding
Affiliations

Sleep and hypertension

David A Calhoun et al. Chest. 2010 Aug.

Abstract

Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.

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Figures

Figure 1.
Figure 1.
Pathophysiologic mechanisms involved in the etiology of OSA-induced hypertension. OSA = obstructive sleep apnea.
Figure 2.
Figure 2.
Plasma aldosterone concentration positively correlates with apnea-hypopnea index and hypoxic index in patients with obstructive sleep apnea and resistant hypertension. AHI = apnea-hypopnea index; HI = hypoxic index; PAC = plasma aldosterone concentration. Reprinted with permission from Pratt-Ubunama et al.
Figure 3.
Figure 3.
Effects of 8 weeks of treatment with spironolactone on apnea-hypopnea index (AHI); hypoxic index; supine AHI; and rapid eye movement sleep AHI at 8 weeks (light gray bars) compared with baseline (dark gray bars) in patients with resistant hypertension. REM = rapid eye movement. See Figure 2 legend for expansion of other abbreviations. *Different compared with baseline (P < .05). Reprinted with permission from Gaddam et al.
See this image and copyright information in PMC

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