Ambulatory BP studies indicate that even small increases in BP, particularly nighttime
BP levels, are associated with significant increases in cardiovascular morbidity and
mortality. Accordingly, sleep-related diseases that induce increases in BP would be
anticipated to substantially affect cardiovascular risk. Both sleep deprivation and
insomnia have been linked to increases in incidence and prevalence of hypertension.
Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood
of having hypertension. Observational studies demonstrate a strong correlation between
the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension,
whereas prospective studies of patients with OSA demonstrate a positive relationship
between OSA and risk of incident hypertension. Intervention trials with continuous
positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in
patients with severe OSA and a greater likelihood of benefit in patients with most
CPAP adherence. Additional prospective studies are needed to reconcile observational
studies suggesting that OSA is a strong risk factor for hypertension with the modest
antihypertensive effects of CPAP observed in intervention studies.
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Article Info
Publication History
Accepted:
February 19,
2010
Received:
December 10,
2009
Footnotes
Funding/Support: This study was funded by the National Institutes of Health, National Heart, Lung, and Blood Institute [Grant 2R01–HL075614-5 , “Etiology of Sleep Apnea-Related Hyperaldosteronism,” David A. Calhoun, Principal Investigator, and Susan M. Harding, Co-investigator].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
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Copyright
© 2010 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.