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Interventional Therapies for Secondary and Essential Hypertension pp 89–118Cite as

Sleep Apnea

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Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

Abstract

Obstructive sleep apnea syndrome (OSAS) is associated with an increased prevalence of hypertension (HTN) and is currently recognized as a cause of secondary HTN [1], with the severity of OSAS being directly correlated with the degree of blood pressure (BP) elevation, with its resistance to antihypertensive treatment and with the presence of alterations in day-to-night BP changes [2–4]. The adverse cardiovascular (CV) prognosis associated with these alterations underlines the importance of OSAS-related hypertension and the need of implementing specific treatment strategies (that is, continuous positive airway pressure (CPAP) in order to promote BP control and optimize CV protection. The present chapter will review the evidence supporting the association of OSAS with often resistant arterial HTN and the proposed mechanisms for this association. It will also address the role of ambulatory blood pressure monitoring (ABPM) in the confirmation of HTN in subjects with OSAS and whether the proper identification and management of OSAS in subjects with resistant HTN will improve BP control. Particular emphasis will be put on the role of CPAP ventilation for the treatment of OSAS, which is known to be effective in reducing the sympathetic nervous system overdrive, a major contributing mechanism for OSAS-related HTN.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

AHI:

Apnea–hypopnea index

baPWV:

Brachial–ankle pulse wave velocity

BMI:

Body mass index

BP:

Blood pressure

cfPWV:

Carotid–femoral pulse wave velocity

CPAP:

Continuous positive air pressure

CRP:

C-reactive protein

CV:

Cardiovascular

eNOS:

Endothelial nitric oxide synthase

ERS:

European Respiratory Society

ESH:

European Society of Hypertension

FMD:

Flow-mediated dilation

HTN:

Hypertension

ICAM-1:

Intercellular adhesion molecule-1

MSNA:

Muscle sympathetic nerve activity

NO:

Nitric oxide

NOS:

Nitric oxide synthase

OSA:

Obstructive sleep apnea

OSAS:

Obstructive sleep apnea syndrome

TNF-alpha:

Tumor necrosis factor-alpha

VCAM-1:

Vascular cell adhesion molecule-1

References

  1. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al (2007) 2007 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). J Hypertens 25(6):1105–1187. Epub 2007/06/15

    Article  CAS  PubMed  Google Scholar 

  2. Grote L, Hedner J, Peter JH (2000) Sleep-related breathing disorder is an independent risk factor for uncontrolled hypertension. J Hypertens 18(6):679–685. Epub 2000/06/29

    Article  CAS  PubMed  Google Scholar 

  3. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384. Epub 2000/05/11

    Article  CAS  PubMed  Google Scholar 

  4. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283(14):1829–1836. Epub 2000/04/19

    Article  CAS  PubMed  Google Scholar 

  5. Medicine AAoS (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  6. Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E (1972) Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physiopathol Respir 8(5):1159–1172. Epub 1972/09/01

    CAS  Google Scholar 

  7. Baguet JP, Hammer L, Levy P, Pierre H, Rossini E, Mouret S et al (2005) Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients. J Hypertens 23(3):521–527. Epub 2005/02/18

    Article  CAS  PubMed  Google Scholar 

  8. Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M (2008) Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep 31(6):795–800. Epub 2008/06/14

    PubMed  PubMed Central  Google Scholar 

  9. Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 320(7233):479–482. Epub 2000/03/04

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Davies CW, Crosby JH, Mullins RL, Barbour C, Davies RJ, Stradling JR (2000) Case–control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax 55(9):736–740. Epub 2000/08/19

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pankow W, Nabe B, Lies A, Becker H, Kohler U, Kohl FV et al (1997) Influence of sleep apnea on 24-hour blood pressure. Chest 112(5):1253–1258. Epub 1997/11/21

    Article  CAS  PubMed  Google Scholar 

  12. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A et al (2000) Association of hypertension and sleep-disordered breathing. Arch Intern Med 160(15):2289–2295. Epub 2000/08/06

    Article  CAS  PubMed  Google Scholar 

  13. Duran J, Esnaola S, Rubio R, Iztueta A (2001) Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 163(3 Pt 1):685–689. Epub 2001/03/20

    Article  CAS  PubMed  Google Scholar 

  14. Tanigawa T, Tachibana N, Yamagishi K, Muraki I, Kudo M, Ohira T et al (2004) Relationship between sleep-disordered breathing and blood pressure levels in community-based samples of Japanese men. Hypertens Res: Off J Jap Soc Hypertens 27(7):479–484. Epub 2004/08/11

    Article  Google Scholar 

  15. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B et al (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157(15):1746–1752. Epub 1997/08/11

    Article  CAS  PubMed  Google Scholar 

  16. Kiely JL, McNicholas WT (2000) Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Res J Off J Eur Soc Clini Res Physiol 16(1):128–133. Epub 2000/08/10

    CAS  Google Scholar 

  17. Calhoun DA (2010) Obstructive sleep apnea and hypertension. Curr Hypertens Rep 12(3):189–195. Epub 2010/04/29

    Article  PubMed  Google Scholar 

  18. Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP (1987) Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 16(2):235–251. Epub 1987/03/01

    Article  CAS  PubMed  Google Scholar 

  19. Bramlage P, Pittrow D, Wittchen HU, Kirch W, Boehler S, Lehnert H et al (2004) Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled. Am J Hypertens 17(10):904–910. Epub 2004/10/16

    Article  PubMed  Google Scholar 

  20. O’Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S et al (2009) Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med 179(12):1159–1164. Epub 2009/03/07

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kapa S, Sert Kuniyoshi FH, Somers VK (2008) Sleep apnea and hypertension: interactions and implications for management. Hypertension 51(3):605–608. Epub 2008/01/30

    Article  CAS  PubMed  Google Scholar 

  22. Haas DC, Foster GL, Nieto FJ, Redline S, Resnick HE, Robbins JA et al (2005) Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation 111(5):614–621. Epub 2005/02/09

    Article  PubMed  Google Scholar 

  23. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M et al (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19(12):2271–2277. Epub 2001/11/29

    Article  CAS  PubMed  Google Scholar 

  24. Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, Miranda-Serrano E, Rubio R, Martinez-Null C et al (2011) Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med 184(11):1299–1304. Epub 2011/08/27

    Article  PubMed  Google Scholar 

  25. Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ et al (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 307(20):2169–2176. Epub 2012/05/24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 118(10):1080–1111. Epub 2008/08/30

    Article  PubMed  Google Scholar 

  27. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 51(6):1403–1419. Epub 2008/04/09

    Article  CAS  PubMed  Google Scholar 

  28. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96(4):1897–1904. Epub 1995/10/01

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Portaluppi F, Provini F, Cortelli P, Plazzi G, Bertozzi N, Manfredini R et al (1997) Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension. J Hypertens 15(11):1227–1233. Epub 1997/12/31

    Article  CAS  PubMed  Google Scholar 

  30. Narkiewicz K, van de Borne PJ, Cooley RL, Dyken ME, Somers VK (1998) Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation 98(8):772–776. Epub 1998/09/04

    Article  CAS  PubMed  Google Scholar 

  31. Ali NJ, Davies RJ, Fleetham JA, Stradling JR (1992) The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest 101(6):1526–1532. Epub 1992/06/01

    Article  CAS  PubMed  Google Scholar 

  32. Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK (1999) Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 100(23):2332–2335. Epub 1999/12/11

    Article  CAS  PubMed  Google Scholar 

  33. Hedner JA, Wilcox I, Laks L, Grunstein RR, Sullivan CE (1992) A specific and potent pressor effect of hypoxia in patients with sleep apnea. Am Rev Respir Dis 146(5 Pt 1):1240–1245. Epub 1992/11/01

    Article  CAS  PubMed  Google Scholar 

  34. Narkiewicz K, van de Borne PJ, Pesek CA, Dyken ME, Montano N, Somers VK (1999) Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation 99(9):1183–1189. Epub 1999/03/09

    Article  CAS  PubMed  Google Scholar 

  35. Parati G, Di Rienzo M, Bonsignore MR, Insalaco G, Marrone O, Castiglioni P et al (1997) Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J Hypertens 15(12 Pt 2):1621–1626. Epub 1998/03/06

    Article  CAS  PubMed  Google Scholar 

  36. Narkiewicz K, Pesek CA, Kato M, Phillips BG, Davison DE, Somers VK (1998) Baroreflex control of sympathetic nerve activity and heart rate in obstructive sleep apnea. Hypertension 32(6):1039–1043. Epub 1998/12/18

    Article  CAS  PubMed  Google Scholar 

  37. Noda A, Nakata S, Koike Y, Miyata S, Kitaichi K, Nishizawa T et al (2007) Continuous positive airway pressure improves daytime baroreflex sensitivity and nitric oxide production in patients with moderate to severe obstructive sleep apnea syndrome. Hypertens Res: Off J Jap Soc Hypertens 30(8):669–676. Epub 2007/10/06

    Article  CAS  Google Scholar 

  38. Ryan S, Ward S, Heneghan C, McNicholas WT (2007) Predictors of decreased spontaneous baroreflex sensitivity in obstructive sleep apnea syndrome. Chest 131(4):1100–1107. Epub 2007/04/12

    Article  PubMed  Google Scholar 

  39. Bonsignore MR, Parati G, Insalaco G, Marrone O, Castiglioni P, Romano S et al (2002) Continuous positive airway pressure treatment improves baroreflex control of heart rate during sleep in severe obstructive sleep apnea syndrome. Am J Respir Crit Care Med 166(3):279–286. Epub 2002/08/03

    Article  PubMed  Google Scholar 

  40. Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK (1998) Altered cardiovascular variability in obstructive sleep apnea. Circulation 98(11):1071–1077. Epub 1998/09/16

    Article  CAS  PubMed  Google Scholar 

  41. Lombardi C, Parati G, Cortelli P, Provini F, Vetrugno R, Plazzi G et al (2008) Daytime sleepiness and neural cardiac modulation in sleep-related breathing disorders. J Sleep Res 17(3):263–270. Epub 2008/05/28

    Article  PubMed  Google Scholar 

  42. Gonzaga CC, Gaddam KK, Ahmed MI, Pimenta E, Thomas SJ, Harding SM et al (2010) Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clini Sleep Med JCSM Official Pub Am Ac Sleep Med 6(4):363–368. Epub 2010/08/24

    Google Scholar 

  43. Pimenta E, Calhoun DA, Oparil S (2009) Sleep apnea, aldosterone, and resistant hypertension. Prog Cardiovasc Dis 51(5):371–380. Epub 2009/03/03

    Article  CAS  PubMed  Google Scholar 

  44. Goodfriend TL, Calhoun DA (2004) Resistant hypertension, obesity, sleep apnea, and aldosterone: theory and therapy. Hypertension 43(3):518–524. Epub 2004/01/21

    Article  CAS  PubMed  Google Scholar 

  45. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM (2004) Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest 125(1):112–117. Epub 2004/01/14

    Article  CAS  PubMed  Google Scholar 

  46. Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA (2007) Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest 131(2):453–459. Epub 2007/02/14

    Article  CAS  PubMed  Google Scholar 

  47. Dudenbostel T, Calhoun DA (2012) Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens 26(5):281–287. Epub 2011/06/10

    Article  CAS  PubMed  Google Scholar 

  48. Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM et al (2010) Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens 24(8):532–537. Epub 2009/12/18

    Article  CAS  PubMed  Google Scholar 

  49. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V et al (2000) Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102(21):2607–2610. Epub 2000/11/22

    Article  CAS  PubMed  Google Scholar 

  50. Ip MS, Tse HF, Lam B, Tsang KW, Lam WK (2004) Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 169(3):348–353. Epub 2003/10/11

    Article  PubMed  Google Scholar 

  51. Jelic S, Lederer DJ, Adams T, Padeletti M, Colombo PC, Factor PH et al (2010) Vascular inflammation in obesity and sleep apnea. Circulation 121(8):1014–1021. Epub 2010/02/18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Butt M, Khair OA, Dwivedi G, Shantsila A, Shantsila E, Lip GY (2011) Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea. Hypertension 58(3):417–424. Epub 2011/07/13

    Article  CAS  PubMed  Google Scholar 

  53. Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D et al (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117(17):2270–2278. Epub 2008/04/17

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 165(7):934–939. Epub 2002/04/06

    Article  PubMed  Google Scholar 

  55. Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N et al (2005) Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 172(5):625–630. Epub 2005/08/27

    Article  PubMed  Google Scholar 

  56. Kanagy NL, Walker BR, Nelin LD (2001) Role of endothelin in intermittent hypoxia-induced hypertension. Hypertension 37(2 Part 2):511–515. Epub 2001/03/07

    Article  CAS  PubMed  Google Scholar 

  57. Ryan S, Taylor CT, McNicholas WT (2005) Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 112(17):2660–2667. Epub 2005/10/26

    Article  CAS  PubMed  Google Scholar 

  58. Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V et al (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105(21):2462–2464. Epub 2002/05/30

    Article  CAS  PubMed  Google Scholar 

  59. Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G et al (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 107(8):1129–1134. Epub 2003/03/05

    Article  CAS  PubMed  Google Scholar 

  60. Ohga E, Nagase T, Tomita T, Teramoto S, Matsuse T, Katayama H et al (1999) Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome. J Appl Physiol 87(1):10–14. Epub 1999/07/20

    CAS  PubMed  Google Scholar 

  61. O’Rourke MF, Nichols WW (2005) Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 45(4):652–658. Epub 2005/02/09

    Article  PubMed  Google Scholar 

  62. Mitchell GF, Lacourciere Y, Ouellet JP, Izzo JL Jr, Neutel J, Kerwin LJ et al (2003) Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension: the role of proximal aortic diameter and the aortic pressure-flow relationship. Circulation 108(13):1592–1598. Epub 2003/09/17

    Article  PubMed  Google Scholar 

  63. Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P et al (2012) Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension 60(2):369–377. Epub 2012/07/04

    Article  CAS  PubMed  Google Scholar 

  64. Doonan RJ, Scheffler P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME et al (2011) Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res: Off J Jap Soc Hypertens 34(1):23–32. Epub 2010/10/22

    Article  Google Scholar 

  65. Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D, Alchanatis M et al (2007) The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens 25(1):141–146. Epub 2006/12/05

    Article  CAS  PubMed  Google Scholar 

  66. Drager LF, Bortolotto LA, Figueiredo AC, Silva BC, Krieger EM, Lorenzi-Filho G (2007) Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest 131(5):1379–1386. Epub 2007/05/15

    Article  PubMed  Google Scholar 

  67. Shiina K, Tomiyama H, Takata Y, Usui Y, Asano K, Hirayama Y et al (2006) Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study. Hypertens Res: Off J Jap Soc Hypertens 29(6):433–441. Epub 2006/08/31

    Article  Google Scholar 

  68. Nagahama H, Soejima M, Uenomachi H, Higashi Y, Yotsumoto K, Samukawa T et al (2004) Pulse wave velocity as an indicator of atherosclerosis in obstructive sleep apnea syndrome patients. Intern Med 43(3):184–188. Epub 2004/04/22

    Article  PubMed  Google Scholar 

  69. Kohler M, Pepperell JC, Casadei B, Craig S, Crosthwaite N, Stradling JR et al (2008) CPAP and measures of cardiovascular risk in males with OSAS. Eur Res J Off J Eur Soc Clini Res Physiol 32(6):1488–1496. Epub 2008/07/26

    CAS  Google Scholar 

  70. Drager LF, Bortolotto LA, Figueiredo AC, Krieger EM, Lorenzi GF (2007) Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 176(7):706–712. Epub 2007/06/09

    Article  CAS  PubMed  Google Scholar 

  71. Rasche K, Keller T, Tautz B, Hader C, Hergenc G, Antosiewicz J et al (2010) Obstructive sleep apnea and type 2 diabetes. Eur J Med Res 15(Suppl 2):152–156. Epub 2010/12/22

    PubMed  PubMed Central  Google Scholar 

  72. Basoglu OK, Sarac F, Sarac S, Uluer H, Yilmaz C (2011) Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome. Ann Thor Med 6(3):120–125. Epub 2011/07/16

    Article  CAS  Google Scholar 

  73. Zirlik S, Hauck T, Fuchs FS, Neurath MF, Konturek PC, Harsch IA (2011) Leptin, obestatin and apelin levels in patients with obstructive sleep apnoea syndrome. Med Sci Monit Inter Med J Exper Clini Res 17(3):CR159–CR164. Epub 2011/03/02

    CAS  Google Scholar 

  74. Bonsignore MR, Esquinas C, Barcelo A, Sanchez-de-la-Torre M, Paterno A, Duran-Cantolla J et al (2012) Metabolic syndrome, insulin resistance and sleepiness in real-life obstructive sleep apnoea. Eur Res J Off J Eur Soc Clini Res Physiol 39(5):1136–1143. Epub 2011/11/15

    CAS  Google Scholar 

  75. Phillips BG, Kato M, Narkiewicz K, Choe I, Somers VK (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279(1):H234–H237. Epub 2000/07/19

    CAS  PubMed  Google Scholar 

  76. McNicholas WT, Bonsigore MR (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Res J Off J Eur Soc Clini Res Physiol 29(1):156–178. Epub 2007/01/02

    CAS  Google Scholar 

  77. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041. Epub 2005/11/12

    Article  CAS  PubMed  Google Scholar 

  78. Selim B, Won C, Yaggi HK (2010) Cardiovascular consequences of sleep apnea. Clin Chest Med 31(2):203–220. Epub 2010/05/22

    Article  PubMed  Google Scholar 

  79. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122(4):352–360. Epub 2010/07/14

    Article  PubMed  PubMed Central  Google Scholar 

  80. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE et al (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182(2):269–277. Epub 2010/03/27

    Article  PubMed  PubMed Central  Google Scholar 

  81. Capampangan DJ, Wellik KE, Parish JM, Aguilar MI, Snyder CR, Wingerchuk D et al (2010) Is obstructive sleep apnea an independent risk factor for stroke? A critically appraised topic. Neurologist 16(4):269–273. Epub 2010/07/02

    Article  PubMed  Google Scholar 

  82. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 31(8):1079–1085. Epub 2008/08/22

    PubMed  PubMed Central  Google Scholar 

  83. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ et al (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071–1078. Epub 2008/08/22

    PubMed  PubMed Central  Google Scholar 

  84. Otto ME, Belohlavek M, Romero-Corral A, Gami AS, Gilman G, Svatikova A et al (2007) Comparison of cardiac structural and functional changes in obese otherwise healthy adults with versus without obstructive sleep apnea. Am J Cardiol 99(9):1298–1302. Epub 2007/05/05

    Article  PubMed  Google Scholar 

  85. Tavil Y, Kanbay A, Sen N, Ciftci TU, Abaci A, Yalcin MR et al (2007) Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension. Int J Cardiovasc Imaging 23(4):469–477. Epub 2006/10/21

    Article  PubMed  Google Scholar 

  86. Agrawal V, Vanhecke TE, Rai B, Franklin BA, Sangal RB, McCullough PA (2009) Albuminuria and renal function in obese adults evaluated for obstructive sleep apnea. Nephron Clin Pract 113(3):c140–c147. Epub 2009/08/13

    Article  PubMed  Google Scholar 

  87. Sim JJ, Rasgon SA, Derose SF (2010) Review article: managing sleep apnoea in kidney diseases. Nephrology (Carlton) 15(2):146–152. Epub 2010/05/18

    Article  Google Scholar 

  88. Persell SD (2011) Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension 57(6):1076–1080. Epub 2011/04/20

    Article  CAS  PubMed  Google Scholar 

  89. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC (2011) Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation 124(9):1046–1058. Epub 2011/08/10

    Article  PubMed  PubMed Central  Google Scholar 

  90. de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P et al (2011) Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 57(5):898–902. Epub 2011/03/30

    Article  PubMed  CAS  Google Scholar 

  91. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520. Epub 2013/12/20

    Article  CAS  PubMed  Google Scholar 

  92. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al (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). J Hypertens 31(7):1281–1357. Epub 2013/07/03

    Article  CAS  PubMed  Google Scholar 

  93. Wolf J, Hering D, Narkiewicz K (2010) Non-dipping pattern of hypertension and obstructive sleep apnea syndrome. Hypertens Res: Off J Jap Soc Hypertens 33(9):867–871. Epub 2010/09/08

    Article  Google Scholar 

  94. Lavie-Nevo K, Pillar G (2006) Evening-morning differences in blood pressure in sleep apnea syndrome: effect of gender. Am J Hypertens 19(10):1064–1069. Epub 2006/10/10

    Article  PubMed  Google Scholar 

  95. Muxfeldt ES, Cardoso CR, Salles GF (2009) Prognostic value of nocturnal blood pressure reduction in resistant hypertension. Arch Intern Med 169(9):874–880. Epub 2009/05/13

    Article  PubMed  Google Scholar 

  96. Muxfeldt ES, Bloch KV, Nogueira AR, Salles GF (2003) Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension. Blood Press Monit 8(5):181–185. Epub 2003/11/19

    Article  PubMed  Google Scholar 

  97. Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW et al (1999) Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 282(6):539–546. Epub 1999/08/18

    Article  CAS  PubMed  Google Scholar 

  98. Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G et al (2005) Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 111(14):1777–1783. Epub 2005/04/06

    Article  PubMed  Google Scholar 

  99. Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S et al (2005) Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 45(2):240–245. Epub 2004/12/15

    Article  CAS  PubMed  Google Scholar 

  100. Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML et al (2008) Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 51(1):55–61. Epub 2007/11/28

    Article  CAS  PubMed  Google Scholar 

  101. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Bjorklund-Bodegard K et al (2007) Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 370(9594):1219–1229. Epub 2007/10/09

    Article  PubMed  Google Scholar 

  102. Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA (2011) Predictive role of the nighttime blood pressure. Hypertension 57(1):3–10. Epub 2010/11/17

    Article  CAS  PubMed  Google Scholar 

  103. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH et al (2003) Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 348(24):2407–2415. Epub 2003/06/13

    Article  PubMed  Google Scholar 

  104. Fagard RH, Van Den Broeke C, De Cort P (2005) Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens 19(10):801–807. Epub 2005/06/17

    Article  CAS  PubMed  Google Scholar 

  105. Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM (1998) Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study. Hypertension 31(2):712–718. Epub 1998/02/14

    Article  CAS  PubMed  Google Scholar 

  106. Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S et al (2005) Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 46(1):156–161. Epub 2005/06/09

    Article  CAS  PubMed  Google Scholar 

  107. Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C (2005) Ambulatory blood pressure and mortality: a population-based study. Hypertension 45(4):499–504. Epub 2005/03/09

    Article  CAS  PubMed  Google Scholar 

  108. Sander D, Kukla C, Klingelhofer J, Winbeck K, Conrad B (2000) Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: a 3-year follow-up study. Circulation 102(13):1536–1541. Epub 2000/09/27

    Article  CAS  PubMed  Google Scholar 

  109. Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V et al (2002) Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med 347(11):797–805. Epub 2002/09/13

    Article  CAS  PubMed  Google Scholar 

  110. Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hashimoto J et al (2006) Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension 47(2):149–154. Epub 2005/12/29

    Article  CAS  PubMed  Google Scholar 

  111. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R et al (2012) Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 30(4):633–646. Epub 2012/03/13

    Article  CAS  PubMed  Google Scholar 

  112. Parati G, Lombardi C, Hedner J, Bonsignore M, Grote L, Tkacova R et al (2013) Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Res J Off J Eur Soc Clini Res Physiol 41(3):523–538

    CAS  Google Scholar 

  113. O’Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G et al (2003) European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 21(5):821–848. Epub 2003/04/26

    Article  PubMed  Google Scholar 

  114. Oikawa T, Obara T, Ohkubo T, Kikuya M, Asayama K, Metoki H et al (2006) Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens 24(9):1737–1743. Epub 2006/08/18

    Article  CAS  PubMed  Google Scholar 

  115. de la Sierra A, Banegas JR, Oliveras A, Gorostidi M, Segura J, de la Cruz JJ et al (2012) Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs. J Hypertens 30(6):1211–1216. Epub 2012/04/25

    Article  PubMed  CAS  Google Scholar 

  116. Pickering TG, Davidson K, Gerin W, Schwartz JE (2002) Masked hypertension. Hypertension 40(6):795–796. Epub 2002/12/07

    Article  CAS  PubMed  Google Scholar 

  117. Parati G, Ulian L, Santucciu C, Omboni S, Mancia G (1998) Difference between clinic and daytime blood pressure is not a measure of the white coat effect. Hypertension 31(5):1185–1189. Epub 1998/05/12

    Article  CAS  PubMed  Google Scholar 

  118. Muxfeldt ES, Bloch KV, Nogueira Ada R, Salles GF (2005) True resistant hypertension: is it possible to be recognized in the office? Am J Hypertens 18(12 Pt 1):1534–1540. Epub 2005/12/21

    Article  PubMed  Google Scholar 

  119. Oliveras A, Armario P, Hernandez-Del Rey R, Arroyo JA, Poch E, Larrousse M et al (2010) Urinary albumin excretion is associated with true resistant hypertension. J Hum Hypertens 24(1):27–33. Epub 2009/05/08

    Article  CAS  PubMed  Google Scholar 

  120. Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM et al (2005) Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 18(11):1422–1428. Epub 2005/11/11

    Article  PubMed  Google Scholar 

  121. Salles GF, Cardoso CR, Muxfeldt ES (2008) Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med 168(21):2340–2346. Epub 2008/11/26

    Article  PubMed  Google Scholar 

  122. Cuspidi C, Macca G, Sampieri L, Michev I, Salerno M, Fusi V et al (2001) High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens 19(11):2063–2070. Epub 2001/10/26

    Article  CAS  PubMed  Google Scholar 

  123. Moser M, Setaro JF (2006) Clinical practice. Resistant or difficult-to-control hypertension. N Engl J Med 355(4):385–392. Epub 2006/07/28

    Article  CAS  PubMed  Google Scholar 

  124. Johansson K, Hemmingsson E, Harlid R, Trolle Lagerros Y, Granath F, Rossner S et al (2011) Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study. BMJ 342:d3017. Epub 2011/06/03

    Article  PubMed  PubMed Central  Google Scholar 

  125. Yee BJ, Phillips CL, Banerjee D, Caterson I, Hedner JA, Grunstein RR (2007) The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea. Int J Obes (Lond) 31(1):161–168. Epub 2006/05/03

    Article  CAS  Google Scholar 

  126. Pannain S, Mokhlesi B (2010) Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism. Best Pract Res Clin Endocrinol Metab 24(5):745–761. Epub 2010/11/30

    Article  PubMed  Google Scholar 

  127. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737. Epub 2004/10/14

    Article  CAS  PubMed  Google Scholar 

  128. Leech JA, Onal E, Lopata M (1992) Nasal CPAP continues to improve sleep-disordered breathing and daytime oxygenation over long-term follow-up of occlusive sleep apnea syndrome. Chest 102(6):1651–1655. Epub 1992/12/01

    Article  CAS  PubMed  Google Scholar 

  129. Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN et al (1993) Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 147(5):1162–1168. Epub1993/05/01

    Article  CAS  PubMed  Google Scholar 

  130. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373(9657):82–93. Epub2008/12/23

    Article  PubMed  Google Scholar 

  131. Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E et al (2007) Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung 185(2):67–72. Epub2007/03/30

    Article  CAS  PubMed  Google Scholar 

  132. Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A et al (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 167(8):757–764. Epub2007/04/25

    Article  PubMed  Google Scholar 

  133. Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 50(2):417–423. Epub2007/06/06

    Article  CAS  PubMed  Google Scholar 

  134. Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107(1):68–73. Epub2003/01/08

    Article  PubMed  Google Scholar 

  135. Logan AG, Tkacova R, Perlikowski SM, Leung RS, Tisler A, Floras JS et al (2003) Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Eur Res J Off J Eur Soc Clini Res Physiol 21(2):241–247. Epub2003/03/01

    CAS  Google Scholar 

  136. Dernaika TA, Kinasewitz GT, Tawk MM (2009) Effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea. J Clini Sleep Med JCSM Official Pub Am Ac Sleep Med 5(2):103–107. Epub2009/12/09

    Google Scholar 

  137. Barbe F, Duran-Cantolla J, Capote F, de la Pena M, Chiner E, Masa JF et al (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726. Epub2009/12/17

    Article  PubMed  Google Scholar 

  138. Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A et al (2010) Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 28(10):2161–2168. Epub2010/06/26

    Article  CAS  PubMed  Google Scholar 

  139. Hu X, Fan J, Chen S, Yin Y, Zrenner B (2015) The role of continuous positive airway pressure in blood pressure control for patients with obstructive sleep apnea and hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich) 17(3):215–222. Epub2015/01/15

    Article  CAS  Google Scholar 

  140. Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M et al (2013) Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 310(22):2407–2415. Epub2013/12/12

    Article  CAS  PubMed  Google Scholar 

  141. Muxfeldt ES, Margallo V, Costa LM, Guimaraes G, Cavalcante AH, Azevedo JC et al (2015) Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial. Hypertension 65(4):736–742. Epub2015/01/21

    Article  CAS  PubMed  Google Scholar 

  142. DiBona GF, Kopp UC (1997) Neural control of renal function. Physiol Rev 77(1):75–197. Epub1997/01/01

    CAS  PubMed  Google Scholar 

  143. Doumas M, Faselis C, Papademetriou V (2011) Renal sympathetic denervation in hypertension. Curr Opin Nephrol Hypertens 20(6):647–653. Epub2011/09/03

    Article  PubMed  Google Scholar 

  144. Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD (2009) Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med 361(9):932–934. Epub2009/08/28

    Article  CAS  PubMed  Google Scholar 

  145. Witkowski A, Prejbisz A, Florczak E, Kadziela J, Sliwinski P, Bielen P et al (2011) Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 58(4):559–565. Epub 2011/08/17

    Article  CAS  PubMed  Google Scholar 

  146. Ziegler MG, Milic M, Sun P (2011) Antihypertensive therapy for patients with obstructive sleep apnea. Curr Opin Nephrol Hypertens 20(1):50–55. Epub 2011/02/18

    Article  CAS  PubMed  Google Scholar 

  147. Pimenta E, Calhoun DA (2010) Treatment of resistant hypertension. J Hypertens 28(11):2194–2195. Epub 2010/10/16

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Gianfranco Parati

  2. Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, IRCCS Istituto Auxologico Italiano and University of Milan-Bicocca, Piazza Brescia 20, Milan, Italy

    Gianfranco Parati, Carolina Lombardi & Juan Eugenio Ochoa

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  2. Carolina Lombardi
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  3. Juan Eugenio Ochoa
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Correspondence to Gianfranco Parati .

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  1. First Cardiology Clinic, National and Kapodistrian University of Athens, Athens, Greece

    Costas Tsioufis

  2. Department of Nephrology and Hypertension, University Hospital Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

    Roland E. Schmieder

  3. IRCCS Istituto Auxologico Italiano, University Milano-Bicocca, Milano Monza, Italy

    Giuseppe Mancia

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Parati, G., Lombardi, C., Ochoa, J.E. (2016). Sleep Apnea. In: Tsioufis, C., Schmieder, R., Mancia, G. (eds) Interventional Therapies for Secondary and Essential Hypertension. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-34141-5_5

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