Mean apnea-hypopnea duration (but not apnea-hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea

Abstract

To determine which polysomnography parameters are associated with severity of hypertension.This retrospective study collected data on all patients admitted to our urban, academic center in Beijing with hypertension who had undergone polysomnograms (PSG) and were diagnosed with obstructive sleep apnea (OSA) (apnea-hyponea index [AHI] ≥5/hour). We then compared polysomnographic parameters (AHI, oxygen desaturation index [ODI], lowest oxygen saturation [LOS], and mean apnea-hypopnea duration [MAD]) by hypertension severity in this cohort.There were 596 subjects who met entry criteria. Age, sex distribution, body mass index (BMI), history of current smoking and alcohol were similar among groups. Subjects with longer MAD suffered from more severe hypertension (P = 0.011). There were no relationship between AHI, ODI, and LOS and hypertension in our cohort. There were no significant differences in age, sex, BMI, history of current smoking and alcohol use between hypertension groups. MAD had a small but significant independent association (odds ratio [OR] = 1.072, 95% confidence interval [CI] 1.019-1.128, P = 0.007) with moderate to severe hypertension, using logistic regression analysis that accounted for age, sex, BMI, history of current smoking and alcohol, AHI, and LOS.Chinese inpatients with longer MAD by PSG face higher odds of moderate to severe hypertension. The mechanism of these effects may be due to aggravated nocturnal hypoxaemia and hypercapnia, as well as disturbed sleep architecture. These results suggest that additional information available in the polysomnogram, such as MAD, should be considered when evaluating OSA patients.

Figure 1

Study design.

Figure 2

The mechanisms of how longer MAD affects blood pressure. MAD = mean apnea–hypopnea duration.