Obstructive sleep apnea and hypertension; critical overview

Abstract

Obstructive sleep apnea (OSA) and hypertension are two important modifiable risk factors for cardiovascular disease and mortality. Numerous studies have highlighted the interplay between these two conditions. We provide a critical review of the current literature on the role of the OSA as a risk factor for hypertension and its effect on blood pressure (BP). We discuss several key topics: the effect of OSA on nocturnal BP, BP response to continuous positive airway pressure (CPAP) treatment, CPAP effect on BP in refractory hypertension, the role of OSA in BP variability (BPV), and maladaptive cardiac remodeling mediated by OSA's effect on BP. Finally, we discuss the unique aspects of ethnicity and social determinants of health on OSA with a focus on Asian populations and the disparity in BP control and cardiovascular outcomes.

Keywords: Blood pressure; Continuous positive airway pressure; Hypertension; Obstructive sleep apnea.

Fig. 1

Mechanisms that may be responsible for hypertension in obstructive sleep apnea: Obstructive sleep apnea increased arterial stiffness, increased renin–angiotensin–aldosterone activity, and altered baroreceptor reflexes