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Prospective Study of Sleep-disordered Breathing and Hypertension

The Sleep Heart Health Study

¹ Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts; ² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ³ University of Pittsburgh, Pittsburgh, Pennsylvania; ⁴ Arizona Respiratory Center, University of Arizona, Tucson, Arizona; ⁵ Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts; ⁶ Department of Medicine, New York University School of Medicine, New York, New York; ⁷ Department of Medicine, Case Western Reserve University, Cleveland, Ohio; ⁸ American Association of Homes and Services for the Aging, Washington, D.C.; and ⁹ Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona

Correspondence and requests for reprints should be addressed to George T. O'Connor, M.D., M.S., Pulmonary Center, Room R304, Boston University School of Medicine, 715 Albany St., Boston, MA 02118. E-mail: goconnor{at}bu.edu

Rationale: Cross-sectional epidemiologic studies show an association between sleep-disordered breathing and hypertension, but only one cohort study has examined sleep-disordered breathing as a risk factor for incident hypertension.

Objectives: To examine whether sleep-disordered breathing increases the risk of incident hypertension among persons 40 years of age and older.

Methods: In a prospective cohort study, we analyzed data from 2,470 participants who at baseline did not have hypertension, defined as blood pressure of at least 140/90 mm Hg or taking antihypertensive medication. The apnea-hypopnea index (AHI), the number of apneas plus hypopneas per hour of sleep, was measured by overnight in-home polysomnography. We estimated odds ratios for developing hypertension during 5 years of follow-up according to baseline AHI.

Measurements and Main Results: The odds ratios for incident hypertension increased with increasing baseline AHI; however, this relationship was attenuated and not statistically significant after adjustment for baseline body-mass index. Although not statistically significant, the observed association between a baseline AHI greater than 30 and future hypertension (odds ratio, 1.51; 95% confidence interval, 0.93–2.47) does not exclude the possibility of a modest association.

Conclusions: Among middle-aged and older persons without hypertension, much of the relationship between AHI and risk of incident hypertension was accounted for by obesity. After adjustment for body mass index, the AHI was not a significant predictor of future hypertension, although a modest influence of an AHI greater than 30 on hypertension could not be excluded.

Key Words: sleep apnea • sleep-disordered breathing • hypertension • cohort study

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Cross-sectional epidemiologic studies reveal an association between sleep-disordered breathing and hypertension, but only one cohort study has examined sleep-disordered breathing as a risk factor for incident hypertension. What This Study Adds to the Field Our prospective cohort study shows that sleep-disordered breathing was not a significant independent risk factor for hypertension after adjusting for the effect of body mass index, although a modest effect on hypertension risk of severe sleep-disordered breathing could not be excluded. These findings may influence clinical decision-making regarding the management of adults with mild-to-moderate sleep-disordered breathing.

 

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