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Nocturnal blood pressure fluctuation and associated influential factors in severe obstructive sleep apnea patients with hypertension

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea syndrome (OSAS) can induce dramatic blood pressure (BP) fluctuations during sleep and it can be associated with hypertension. We investigated the properties and associated influential factors of BP fluctuation in severe OSAS with and without hypertension.

Methods

Two hundred one severe OSAS subjects were divided into hypertensive and normotensive groups. BP was continuously monitored via measurement of pulse transmit time (PTT). The value of apnea-related systolic BP elevation (ΔSBP) was used to reflect the amplitude of BP fluctuation, and the SBP index (the number of ΔSBP > 10 mmHg per hour of sleep time) was used to stand for the frequency of significant BP fluctuations.

Results

Compared with the normotensive group, △SBP and SBP index were higher in the hypertensive group (13.8 ± 4.4 mmHg vs 10.9 ± 3.1 mmHg; 44.8 ± 21.3 events/h vs 26.8 ± 15.8 events/h, all p < 0.001). Multiple regression analysis showed that percentage of sleep time with oxygen saturation < 90% (TST90) and SBP index correlated more with mean level of awakeness and sleep SBP than with apnea-hypopnea index (AHI). Analysis of all apnea events demonstrated that △SBP and the frequency of BP fluctuations were more remarkable following hypoxia than following arousal; △SBP correlated more with oxygen desaturation degree (r = 0.388, p < 0.01) and minimal SpO2 (r = 0.392, p < 0.01) than with apnea length and desaturation duration.

Conclusions

In severe OSAS, nocturnal and awake BP levels are associated more with the nocturnal hypoxic duration and BP fluctuation than with AHI. Nocturnal BP fluctuation can be induced by both hypoxia and arousal, and especially by hypoxia.

Trial registration

NCT02876471

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Acknowledgments

The authors would like to thank all patients included in this research.

Author information

Author notes

  1. Ning Ding and Xilong Zhang contributed equally to the first author Jing Xu.

Authors and Affiliations

  1. Department of Respiratory, Huai’an First People’s Hospital, Nanjing Medical University, 6 Beijing Road West, Huai’an, 223300, Jiangsu, People’s Republic of China

    Jing Xu, Nana Wang, Bing Sun, Rong Zhang, Xiaochen Xie, Zongren Wan, Yanli Gu, Shan Zhang, Yongqing Hong & Zili Meng

  2. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Ning Ding, Xilong Zhang & Mao Huang

Authors
  1. Jing Xu
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  2. Ning Ding
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  5. Bing Sun
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  9. Yanli Gu
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  10. Shan Zhang
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  11. Yongqing Hong
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  12. Mao Huang
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Corresponding authors

Correspondence to Mao Huang or Zili Meng.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Scientific Research and Technology Ethics Committee of Huai’an First People’s Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Xu, J., Ding, N., Zhang, X. et al. Nocturnal blood pressure fluctuation and associated influential factors in severe obstructive sleep apnea patients with hypertension. Sleep Breath 22, 1045–1052 (2018). https://doi.org/10.1007/s11325-018-1634-6

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  • DOI: https://doi.org/10.1007/s11325-018-1634-6

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