CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(S 01): 001-070
DOI: 10.1055/s-0043-1770170
ID: 1260

Obstructive Sleep Apnea and Hypertension-mediated Organ Damage in Nonresistant and Resistant Hypertension

M. L. Cabrini
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
T. A. Macedo
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
E. Castro
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
S. De Barros
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
I. Azam
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
A. Pio-Abreu
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
G. V. Silva
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
G. Lorenzi-Filho
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
L. A. Bortolotto
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
,
L. F. Drager
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
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    Keywords

    sleep apnea - heart - hypertension - resistant - target-organ damage

    Introduction: Obstructive Sleep Apnea (OSA) is common in patients with hypertension, especially in those with Resistant Hypertension (RH). However, it is unclear whether OSA can contribute to target-organ damage in patients with non-resistant hypertension (NRH) and in patients with RH.

    Aim: This study aims to evaluate the potential impact of OSA on Hypertension-Mediated Organ Damage (HMOD) in patients with NRH and RH.

    Methods: We included patients with hypertension without diabetes from a Tertiary Center to perform a clinical evaluation, a sleep study to define OSA (apnoea-hypopnoea index ≥ 15 events/h), and standard analysis of four HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy and nephropathy) in a blinded fashion. RH was diagnosed by uncontrolled blood pressure (BP) (≥ 140/90 mm Hg) despite using at least three antihypertensive classes or patients with controlled BP using ≥ 4 classes at optimal doses. To avoid the white-coat effect, we performed an ambulatory BP monitoring to confirm the RH diagnosis.

    Results: One-hundred patients were included in the analysis (mean age: 54 ± 8 years, 65% female, body mass index: 30.4 ± 4.5 kg/m2). OSA was detected in 52% of patients. In patients with NRH (n = 53), the presence of OSA (52.8%) was not associated with increased frequency of HMOD. In contrast, among patients with RH, OSA (51.1%) was associated with an increased rate of LVH (RH-OSA: 61%; RH+OSA: 87%; p = 0.049). Considering the total sample, logistic regression analysis showed that RH (OR: 8.43; 95% CI: 2.51–28.37; p < 0.001) and OSA (OR: 4.67; 95% CI: 1.24–17.62; p = 0.023) were independently associated with LVH. No significant associations were observed between OSA for arterial stiffness, retinopathy or nephropathy.

    Conclusions: OSA is independently associated with LVH in RH, suggesting a potential role of OSA in the RH prognosis.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    15 June 2023

    © 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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