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Review
. 2024 Dec 1;63(23):3131-3136.
doi: 10.2169/internalmedicine.2960-23. Epub 2024 Apr 16.

Blood Pressure Regulation and Hypertension in Obstructive Sleep Apnea Syndrome: A Historical Perspective

Fumihiko Yasuma  1 , Akiko Noda  1   2 , Junichiro Hayano  3
Affiliations
Review

Blood Pressure Regulation and Hypertension in Obstructive Sleep Apnea Syndrome: A Historical Perspective

Fumihiko Yasuma et al. Intern Med. .

Abstract

In obstructive sleep apnea syndrome (OSAS), an underlying disease of secondary hypertension, repeated episodes of asphyxia due to obstructive sleep apnea (OSA), followed by arousal, lead to various cardiovascular consequences. Using a canine model of OSAS, it was found that a single load of OSA caused an abrupt increase in blood pressure (BP) (Apnea Surge in seconds), while multiple OSA episodes occurring nightly for 1-3 months led to a sustained elevation of BP during both nighttime and daytime. Epidemiological studies on 24-hour ambulatory BP measurements revealed that some hypertensive patients experienced elevated BP in the early morning (Morning Surge), which could be intensified by OSAS. The resonance of Apnea Surge in seconds and Morning Surge increases the risk of organ damage, triggers the cardiovascular events, and adversely affects the prognosis of hypertensive patients with OSAS. For ameliorating these risks, OSA should be treated with positive airway pressure properly.

Keywords: Morning Surge; apnea surge; blood pressure; hypertension; obstructive sleep apnea.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Parallel circuit configuration of the power supply and systemic circulation. The parallel circuit configuration of the commercial power supply and systemic circulation maintained optimum voltage and blood pressure, respectively. Each circuit allowed for efficient distribution of electricity and blood flow, ensuring stable operation of the system. The figure was modified and then reproduced from Figure 16-2 (page 237) of Reference (21) (Yasuma F, 2010).
Figure 2.
Figure 2.
Apnea Surge in seconds in the acute canine model of OSAS. From top to bottom, tidal volume (TV), RR interval (RRI) of electrocardiography, high-frequency power (0.04-0.40 Hz) of the RRI (RRHF), and mean blood pressure (MBP) are shown. The first arrow at the top is the start of airway obstruction during sleep and the second arrow is its release, which coincides with arousal. The figure was modified and then reproduced from Figure 4 (page 618) of Reference (14) (Yasuma F, et al., 1998).
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