Moderate to severe obstructive sleep apnea is independently associated with inter-arm systolic blood pressure difference

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kazuki Shiina ◽  
Yoshifumi Takata ◽  
Hiroki Nakano ◽  
Masatsune Fujii ◽  
Yoichi Iwasaki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Systolic Blood Pressure ◽  
Pressure Difference ◽  
Severe Obstructive Sleep Apnea ◽  
Blood Pressure Difference ◽  
Obstructive Sleep

Abstract P159: Moderate To Severe Obstructive Sleep Apnea Is Independently Associated With Inter-arm Systolic Blood Pressure Difference: Tokyo Sleep Heart Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Kazuki Shiina ◽  
Hirofumi Tomiyama ◽  
Hiroki Nakano ◽  
Fujii Masatsune ◽  
Taishiro Chikamori
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Systolic Blood Pressure ◽  
Pressure Difference ◽  
Blood Pressure Measurement ◽  
Apnea Hypopnea Index ◽  
Blood Pressure Difference ◽  
Heart Study ◽  
Obstructive Sleep

Objective: Obstructive sleep apnea (OSA) is recognized as an independent risk factor for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD), inter-ankle systolic blood pressure difference (IAND), and ankle-brachial index (ABI) are all known predictors of cardiovascular events. The aim of the present study was to investigate the association between OSA and four-limb blood pressure differences. Methods: We conducted this cross-sectional study in a large sleep cohort from Tokyo Sleep Heart Study. In 2643 consecutive patients who visited our sleep clinic for polysomnography between 2005 and 2017; all the subjects underwent blood pressure measurement simultaneously in all the four limbs by oscillometric methods. Results: The prevalence rate of IAD ≥ 10 mm Hg was significantly higher in the severe OSA (apnea-hypopnea index ≥ 30) group (4.6%) than in the no/mild (apnea-hypopnea index < 15) OSA group (1.6%). Multivariate logistic regression analysis also identified moderate to severe OSA as being significantly associated with IAD ≥ 10 mm Hg, even after adjustments for confounding variables [moderate OSA; odds ratio (OR): 3.627, 95% confidence interval (CI): 1.056-12.465, P = 0.041. Severe OSA; OR: 3.778, 95% CI: 1.113-12.595, P = 0.031]. However, there were no significant associations of the OSA severity with IAND ≥ 15 mm Hg or ABI < 0.9. Conclusions: Moderate to severe OSA was independently associated with the IAD, not but with the IAND or ABI. The plausible explanation is that the negative intrathoracic pressure caused by OSA may exert an adverse impact on the structural properties of the thoracic aorta. Our findings emphasized that physicians should be careful of IAD, easily applied clinical tool, to evaluate subclinical cardiovascular damage and cardiovascular risk in patients with OSA.

scholarly journals INTER-ARM BLOOD PRESSURE DIFFERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

2021 ◽  
Vol 39 (Supplement 1) ◽  
pp. e362
Author(s):  
Kazuki Shiina ◽  
Hirofumi Tomiyama ◽  
Taishiro Chikamori
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pressure Difference ◽  
Blood Pressure Difference ◽  
Obstructive Sleep

scholarly journals The effect of antihypertensive therapy and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea syndrome in association with arterial hypertension

2017 ◽  
Vol 14 (1) ◽  
pp. 37-40
Author(s):  
E M Elfimova ◽  
A V Rvacheva ◽  
M I Tripoten ◽  
O V Pogorelova ◽  
T V Balakhonova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Endothelial Dysfunction ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Adhesion Molecule ◽  
Severe Obstructive Sleep Apnea ◽  
Cpap Therapy ◽  
Obstructive Sleep

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

scholarly journals Predictors of chronic kidney disease in obstructive sleep apnea patients

2020 ◽  
Vol 15 ◽  
Author(s):  
Phunphai Somkearti ◽  
Paiboon Chattakul ◽  
Sittichai Khamsai ◽  
Panita Limpawattana ◽  
Jarin Chindaprasirt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
High Systolic Blood Pressure ◽  
Mallampati Score ◽  
Obstructive Sleep

Introduction: Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD. Objective: This study aimed to identify the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients. Methods: This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA via polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing >5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis. Results: During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m2, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 vs 135 mmHg), proportion of patients with diabetes (55% vs 34%), and proportion of patients with Mallampati scores of 3-4 (73% vs 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.757), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively. Conclusions: Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.

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