TY - JOUR
T1 - The association between obstructive sleep apnea characterized by a minimum 3 percent oxygen desaturation or arousal hypopnea definition and hypertension
AU - Budhiraja, Rohit
AU - Javaheri, Sogol
AU - Parthasarathy, Sairam
AU - Berry, Richard B.
AU - Quan, Stuart F.
N1 - Funding Information:
SHHS acknowledges the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, the Cornell/Mt. Sinai Worksite and Hypertension Studies, the Strong Heart Study, the Tucson Epidemiologic Study of Airways Obstructive Diseases (TESAOD), and the Tucson Health and Environment Study for allowing their cohort members to be part of the SHHS and for sharing such data for the purposes of this study. SHHS is particularly grateful to the members of these cohorts who agreed to participate in SHHS as well. SHHS further recognizes all the investigators and staff who have contributed to its success. A list of SHHS investigators, staff, and their participating institutions is available on the SHHS website (www.jhsph.edu/shhs). The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service. This work was supported by National Heart, Lung and Blood Institute cooperative agreements U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53934 (University of Minnesota), U01HL53931 (New York University), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL63463 (Case Western Reserve University), U01HL63429 (Missouri Breaks Research). All authors have read and approve this manuscript. Dr. Budhiraja reports no conflicts of interest or grant funding. Dr. Quan reports research funding from the National Institutes of Health, serves as a consultant to Jazz Pharmaceuticals and is a vice committee chair for the American Academy of Sleep Medicine. Dr. Javaheri serves as a consultant for Jazz Pharmaceuticals. Dr. Berry reports research funding from Philips Respironics, Res Med and the University of Florida Foundation. Dr. Parthasarathy reports grants from NIH/NHLBI as PI (HL138377, HL126140; IPA-014264-00001; HL095799) or site PI (HL128954; UG3HL140144), grants from Patient Centered Outcomes Research Institute as PI (IHS-1306-02505; EAIN-3394-UOA) or site-investigator (PCS-1504-30430), grants from US Department of Defense as co-investigator (W81XWH-14-1-0570), grants from NIH/NCI as co-investigator (R21CA184920) and NIH/NIMHD as co-investigator (MD011600), grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, non-financial support from National Center for Sleep Disorders Research of the NIH (NHLBI), personal fees from UpToDate Inc., grants from Younes Sleep Technologies, Ltd., personal fees from Vapotherm, Inc., personal fees from Merck, Inc., grants from Philips-Respironics, Inc., personal fees from Philips-Respironics, Inc., personal fees from Bayer, Inc., personal fees from Nightbalance, Inc, personal fees from Merck, Inc, grants from American Academy of Sleep Medicine Foundation (169-SR-17); In addition, Dr. Parthasarathy has a patent UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home breathing device) issued.
Funding Information:
All authors have read and approve this manuscript. Dr. Budhiraja reports no conflicts of interest or grant funding. Dr. Quan reports research funding from the National Institutes of Health, serves as a consultant to Jazz Pharmaceuticals and is a vice committee chair for the American Academy of Sleep Medicine. Dr. Javaheri serves as a consultant for Jazz Pharmaceuticals. Dr. Berry reports research funding from Philips Respironics, Res Med and the University of Florida Foundation. Dr. Parthasarathy reports grants from NIH/NHLBI as PI (HL138377, HL126140; IPA-014264-00001; HL095799) or site PI (HL128954; UG3HL140144), grants from Patient Centered Outcomes Research Institute as PI (IHS-1306-02505; EAIN-3394-UOA) or site-investigator (PCS-1504-30430), grants from US Department of Defense as co-investigator (W81XWH-14-1-0570), grants from NIH/NCI as co-investigator (R21CA184920) and NIH/NIMHD as coinvestigator (MD011600), grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, non-financial support from National Center for Sleep Disorders Research of the NIH (NHLBI), personal fees from UpToDate Inc., grants from Younes Sleep Technologies, Ltd., personal fees from Vapotherm, Inc., personal fees from Merck, Inc., grants from Philips-Respironics, Inc., personal fees from Philips-Respironics, Inc., personal fees from Bayer, Inc., personal fees from Nightbalance, Inc, personal fees from Merck, Inc, grants from American Academy of Sleep Medicine Foundation (169-SR-17); In addition, Dr. Parthasarathy has a patent UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home breathing device) issued.
Funding Information:
SHHS acknowledges the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, the Cornell/Mt. Sinai Worksite and Hypertension Studies, the Strong Heart Study, the Tucson Epidemiologic Study of Airways Obstructive Diseases (TESAOD), and the Tucson Health and Environment Study for allowing their cohort members to be part of the SHHS and for sharing such data for the purposes of this study. SHHS is particularly grateful to the members of these cohorts who agreed to participate in SHHS as well. SHHS further recognizes all the investigators and staff who have contributed to its success. A list of SHHS investigators, staff, and their participating institutions is available on the SHHS website (www.jhsph.edu/shhs). The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service. This work was supported by National Heart, Lung and Blood Institute cooperative agreements U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53934 (University of Minnesota), U01HL53931 (New York University), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL63463 (Case Western Reserve University), U01HL63429 (Missouri Breaks Research).
Publisher Copyright:
© 2019 American Academy of Sleep Medicine. All rights reserved.
PY - 2019/9/15
Y1 - 2019/9/15
N2 - Study Objectives: The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O2 desaturation. However, the American Academy of Sleep Medicine (AASM) recommends using a 3% O2 desaturation or an arousal. This analysis assesses the relationship between OSA and hypertension utilizing the AASM recommended definition and the 2018 American College of Cardiology/ American Heart Association hypertension guidelines. Methods: Data from 6113 participants from the Sleep Heart Health Study were analyzed. The AASM recommended apnea-hypopnea index (AHI) was classified into 4 categories of OSA severity: < 5, 5 to < 15, 15 to < 30 and ≥ 30 events/h. Three definitions of hypertension were used: elevated (> 120/< 80 or use of hypertension medications [meds]), stage 1/stage 2 (> 130/80 or meds), stage 2 (> 140/90 or meds). Data were analyzed using logistic regression controlling for demographics, smoking and body mass index. Multiple linear regression analysis assessed the relationship between natural log AHI, and systolic and diastolic blood pressure controlling for the same covariates. Results: For all definitions of blood pressure elevation, increasing OSA severity was associated with greater likelihood of an elevated or hypertensive status in fully adjusted models (odds ratio [95% confidence interval]): elevated 1.30 (1.09–1.54), 1.39 (1.13–1.70) 1.69 (1.29–2.13); stage 1/2: 1.25 (1.06–1.47), 1.32 (1.10–1.59), 1.53 (1.23–1.91); stage 2: 1.07 (0.91–1.25), 1.21 (1.01–1.44), 1.37 (1.11–1.69) for AHI 5 to < 15, 15 to < 30 and > 30 events/h (< 5 events/h reference). Linear regression found that AHI was associated with both systolic and diastolic blood pressure in fully adjusted models. Conclusions: Use of the AASM recommended definition of hypopnea as a component of the AHI is associated with the presence of hypertension.
AB - Study Objectives: The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O2 desaturation. However, the American Academy of Sleep Medicine (AASM) recommends using a 3% O2 desaturation or an arousal. This analysis assesses the relationship between OSA and hypertension utilizing the AASM recommended definition and the 2018 American College of Cardiology/ American Heart Association hypertension guidelines. Methods: Data from 6113 participants from the Sleep Heart Health Study were analyzed. The AASM recommended apnea-hypopnea index (AHI) was classified into 4 categories of OSA severity: < 5, 5 to < 15, 15 to < 30 and ≥ 30 events/h. Three definitions of hypertension were used: elevated (> 120/< 80 or use of hypertension medications [meds]), stage 1/stage 2 (> 130/80 or meds), stage 2 (> 140/90 or meds). Data were analyzed using logistic regression controlling for demographics, smoking and body mass index. Multiple linear regression analysis assessed the relationship between natural log AHI, and systolic and diastolic blood pressure controlling for the same covariates. Results: For all definitions of blood pressure elevation, increasing OSA severity was associated with greater likelihood of an elevated or hypertensive status in fully adjusted models (odds ratio [95% confidence interval]): elevated 1.30 (1.09–1.54), 1.39 (1.13–1.70) 1.69 (1.29–2.13); stage 1/2: 1.25 (1.06–1.47), 1.32 (1.10–1.59), 1.53 (1.23–1.91); stage 2: 1.07 (0.91–1.25), 1.21 (1.01–1.44), 1.37 (1.11–1.69) for AHI 5 to < 15, 15 to < 30 and > 30 events/h (< 5 events/h reference). Linear regression found that AHI was associated with both systolic and diastolic blood pressure in fully adjusted models. Conclusions: Use of the AASM recommended definition of hypopnea as a component of the AHI is associated with the presence of hypertension.
KW - Apnea-hypopnea index
KW - Blood pressure
KW - Hypertension
KW - Obstructive sleep apnea
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U2 - 10.5664/jcsm.7916
DO - 10.5664/jcsm.7916
M3 - Article
C2 - 31482814
AN - SCOPUS:85072345841
VL - 15
SP - 1261
EP - 1270
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
SN - 1550-9389
IS - 9
ER -