The effect of high evening blood pressure on obstructive sleep apnea–related morning blood pressure elevation: does sex modify this interaction effect?
- 21 Downloads
Obstructive sleep apnea (OSA) can lead to increased morning blood pressure (BP). We hypothesized that high evening BP may aggravate OSA-related morning BP elevation. Additionally, this interactional effect may be modified by sex.
This retrospective, cross-sectional study included newly diagnosed OSA patients with an apnea-hypopnea index (AHI) ≥ 5 per hour on a full-night polysomnography. An analysis of covariance (ANCOVA) was used to determine whether severe OSA (AHI ≥ 30) was associated with higher morning BP than mild-to-moderate OSA (5 ≤ AHI < 30) and whether there was an interaction between apnea severity and evening BP on morning BP. To identify the sex effects, analyses were performed separately in each sex group.
A total of 1445 patients with an average age of 51.9 years (SD 11.7) (male 77.9% vs. female 22.1%; high evening BP group 22.4% vs. normal evening BP group 59.6%) were included in the study. Based on the ANCOVA, patients with severe OSA had significantly higher morning systolic BP (SBP) (p = 0.003), diastolic BP (DBP) (p < 0.001), and mean BP (MBP) (p < 0.001) than the mild-to-moderate group in male subjects. A significant interaction between apnea severity and evening BP was identified on morning DBP and MBP in male subjects. However, there were no differences in morning BP between severe and mild-to-moderate OSA groups in female subjects.
In male subjects, severe OSA contributed to higher morning BP than mild-to-moderate OSA. OSA-associated morning BP elevation was more prominent in the high evening BP group than in the normal BP group. Such relations were not found in female subjects.
KeywordsObstructive sleep apnea Blood pressure Hypertension Sex Diastolic blood pressure Morning blood pressure
This report was supported by the Asan Medical Center.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Mokros L, Kuczynski W, Franczak L, Bialasiewicz P (2017) Morning diastolic blood pressure may be independently associated with severity of obstructive sleep apnea in non-hypertensive patients: a cross-sectional study. J Clin Sleep Med 13(7):905–910. https://doi.org/10.5664/jcsm.6664 CrossRefGoogle Scholar
- 8.Kapa S, Sert Kuniyoshi FH, Somers VK (2008) Sleep apnea and hypertension: interactions and implications for management. Hypertension 51(3):605–608. https://doi.org/10.1161/hypertensionaha.106.076190 CrossRefGoogle Scholar
- 15.Walia HK, Li H, Rueschman M, Bhatt DL, Patel SR, Quan SF, Gottlieb DJ, Punjabi NM, Redline S, Mehra R (2014) Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. J Clin Sleep Med 10(8):835–843. https://doi.org/10.5664/jcsm.3946 Google Scholar
- 16.Kasiakogias A, Tsioufis C, Thomopoulos C, Andrikou I, Aragiannis D, Dimitriadis K, Tsiachris D, Bilo G, Sideris S, Filis K, Parati G, Stefanadis C (2015) Evening versus morning dosing of antihypertensive drugs in hypertensive patients with sleep apnoea: a cross-over study. J Hypertens 33(2):393–400. https://doi.org/10.1097/hjh.0000000000000371 CrossRefGoogle Scholar
- 17.Serinel Y, Yee BJ, Grunstein RR, Wong KH, Cistulli PA, Arima H, Phillips CL (2017) Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial. Thorax 72(6):550–558. https://doi.org/10.1136/thoraxjnl-2016-209504 CrossRefGoogle Scholar
- 23.Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Burnier M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Ferrari R, Hasdai D, Hoes AW, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Gillebert TC, Rosei EA, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Vlachopoulos C, Volpe M, Wood DA (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219. https://doi.org/10.1093/eurheartj/eht151 CrossRefGoogle Scholar
- 24.Armstrong C (2014) JNC8 guidelines for the management of hypertension in adults. Am Fam Physician 90(7):503–504Google Scholar
- 25.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6):1206–1252. https://doi.org/10.1161/01.HYP.0000107251.49515.c2 CrossRefGoogle Scholar
- 27.Schulz H (2007) Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 3(7):752Google Scholar
- 28.Dean DA, Wang R, Jacobs DR, Duprez D, Punjabi NM, Zee PC, Shea S, Watson K, Redline S (2015) A systematic assessment of the association of polysomnographic indices with blood pressure: the Multi-Ethnic Study of Atherosclerosis (MESA). Sleep 38(4):587–596. https://doi.org/10.5665/sleep.4576 CrossRefGoogle Scholar
- 29.Jin ZN, Wei YX (2016) Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system. J Geriatr Cardiol 13(4):333–343. https://doi.org/10.11909/j.issn.1671-5411.2016.03.020 Google Scholar
- 32.Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093. https://doi.org/10.1161/circulationaha.107.185649 CrossRefGoogle Scholar
- 33.Hinojosa-Laborde C, Mifflin SW (2005) Sex differences in blood pressure response to intermittent hypoxia in rats. Hypertension 46(4):1016–1021. https://doi.org/10.1161/01.HYP.0000175477.33816.f3 CrossRefGoogle Scholar
- 34.Stupfel M, Pesce VH, Gourlet V, Bouley G, Elabed A, Lemercerre C (1984) Sex-related factors in acute hypoxia survival in one strain of mice. Aviat Space Environ Med 55(2):136–140Google Scholar
- 35.Milnor WR (1990) Cardiovascular physiology. Oxford University PressGoogle Scholar
- 38.Cho JS, Ihm SH, Kim CJ, Park MW, Her SH, Park GM, Kim TS (2015) Obstructive sleep apnea using watch-PAT 200 is independently associated with an increase in morning blood pressure surge in never-treated hypertensive patients. J Clin Hypertens (Greenwich) 17(9):675–681. https://doi.org/10.1111/jch.12581 CrossRefGoogle Scholar
- 42.(2017) Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus. Kidney Int Rep 2 (4):733–738. https://doi.org/10.1016/j.ekir.2017.02.009
- 43.Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 138(17):e426–e483. https://doi.org/10.1161/cir.0000000000000597 Google Scholar
- 44.Mbanya VN, Mbanya JC, Kufe C, Kengne AP (2016) Effects of single and multiple blood pressure measurement strategies on the prediction of prevalent screen-detected diabetes mellitus: a population-based survey. J Clin Hypertens (Greenwich) 18(9):864–870. https://doi.org/10.1111/jch.12774 CrossRefGoogle Scholar