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Review
. 2022 Jun;24(6):173-184.
doi: 10.1007/s11906-022-01181-w. Epub 2022 Mar 5.

Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship

John Brown  1 , Farshid Yazdi  2 , Mona Jodari-Karimi  1 , Jonathan G Owen  3 , Efrain Reisin  4
Affiliations
Review

Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship

John Brown et al. Curr Hypertens Rep. 2022 Jun.

Abstract

Purpose of review: Obstructive sleep apnea (OSA) is an underdiagnosed illness linked to essential hypertension (HTN), resistant hypertension (r-HTN), and cardiovascular disease (CVD). This review provides updates on the epidemiology, pathophysiology, and treatments of OSA-associated HTN.

Recent findings: Mild sleep apnea increases the risk for HTN. Eighty-nine percent of young patients aged 18-35 with HTN not attributed to secondary causes have underlying OSA. Home sleep studies are noninferior to formal polysomnography for OSA diagnosis. Nocturnal oxygen desaturation rate is positively correlated with HTN severity. Gut microbiome neo-colonization in response to high-fat diet cravings in patients with OSA alters immune function and worsens HTN. Carbonic anhydrase inhibitors and probiotics show newfound potential for OSA-associated HTN treatment. OSA recognition improves hospital outcomes after a STEMI. Hypoxia-inducible factor (HIF) transcription increases in a dose-dependent manner to hypoxia, and HIFs are strongly linked to cancer growth. OSA and HTN are comorbid conditions with adversely connected pathophysiology including sympathetic hyperactivity, gut dysbiosis, proinflammation, endothelial damage, rostral fluid shifts, pharyngeal collapse, intravascular fluid retention, nocturnal energy expenditure, and metabolic derangements. The dose-response effect of OSA on HTN severity challenges blood pressure (BP) control, so those with refractory HTN should be screened for OSA.

Keywords: Apnea–hypopnea index (AHI); Gut dysbiosis; Hypertension; Obstructive sleep apnea (OSA); Resistant hypertension; Sleep-disordered breathing (SDB).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The connected pathophysiology of OSA and HTN. The green box is the STOP-BANG criteria. Black arrows represent acute physiological occurrences during apneic sleep. Purple arrows represent long-term physiological changes that result of chronic OSA. These chronic derangements lead to resistant, worsening HTN, which is displayed in the red box
See this image and copyright information in PMC

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