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. 2019 Jul 15;15(7):957-963.
doi: 10.5664/jcsm.7870.

Nondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension

Sophie J Crinion  1   2 , Silke Ryan  1   2 , Jana Kleinerova  1 , Brian D Kent  1   2 , Joseph Gallagher  3 , Mark Ledwidge  3 , Kenneth McDonald  2   3 , Walter T McNicholas  1   2   4
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Nondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension

Sophie J Crinion et al. J Clin Sleep Med. .

Abstract

Study objectives: Systemic hypertension is highly prevalent in obstructive sleep apnea (OSA) but there are limited data on OSA prevalence in cohorts with hypertension comparing dippers and nondippers. We investigated this relationship in a clinic-based cohort of patients with hypertension who were not screened for any pretest possibility of OSA.

Methods: A total of 100 patients with hypertension aged (mean ± SD) 58 ± 10 years, body mass index 30.5 ± 6.1 kg/m2, and Epworth Sleepiness Scale score 6 ± 4 were included. All underwent overnight attended sleep studies and 24-hour ambulatory blood pressure monitoring. The primary study end-point was OSA prevalence based on the standard criteria of apnea-hypopnea index (AHI) ≥ 15 events/h in patients with dipping and nondipping nocturnal blood pressure.

Results: Results showed 10.5% of dippers and 43.5% of nondippers had an AHI ≥ 15 (chi-square P = .001). In univariate analysis, AHI correlated significantly with blood pressure dip (r = -.26, P < .05), as did ESS (r = -.28, P < .05). In linear regression, AHI predicted the magnitude of blood pressure dip (standardised β = -.288, P = .03), whereas age, body mass index, systolic blood pressure and diastolic blood pressure did not.

Conclusions: Patients with nondipping nocturnal blood pressure are at high risk of OSA, regardless of symptom profile, which supports the recommendation that such patients should be assessed for co-existing OSA.

Keywords: blood pressure; hypertension; nondipping; sleep apnea.

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Figures

Figure 1
Figure 1. Prevalence of OSA among dipper and nondipper participants with hypertension.
(A) Prevalence of significant OSA (AHI > 15 events/h) among dipper and nondipper participants with hypertension. (B) Prevalence of any SDB (AHI > 5 events/h) and severe OSA (AHI > 30 events/h) among dipper and nondipper participants with hypertension. Data are presented as percentage of cohort (%). * P = .054, ** P = .001. AHI = apnea-hypopnea index, OSA = obstructive sleep apnea, SDB = sleep-disordered breathing.
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