Untreated obstructive sleep apnea resistant to treatment increases blood pressure
Obstructive sleep apnea is a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe
Dr. Harneet Walia, MD, Assistant Professor in the Clinic Lerner College of Medicine of Case Western Reserve University and first author of this new study along with colleagues hypothesized that untreated severe obstructive sleep apnea (OSA) s associated with elevated ambulatory blood pressure in subjects with high cardiovascular disease (CVD) risk despite anti-hypertensive medication use.
The study involved 248 participants with an average age of 63.1 years with severe OSA (23.6%), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP and 9.9% had resistant elevated BP.
The results showed that participants prescribed at least three ant-ihypertensive including a diuretic, resistant elevated blood pressure was more prevalent in those with severe sleep apnea (58.3 %) compared with moderate sleep apnea (28.6%).
A further analysis had showed that participants with OSA had a four-fold higher risk of resistant elevated blood pressure even after adjusting for potential confounders such as body mass index, smoking status , diabetes and cardiovascular disease.
In their conclusion the team writes “Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite aggressive medication use
Dr. Walia, commented "This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk."
Dr. Walia continues "Even under the close care of a cardiologist following national guidelines for treatment of cardiovascular risk and comprehensive medication regimens, severe levels of obstructive sleep apnea versus a moderate level of OSA appear to be contributing to suboptimal blood pressure control.”
Dr. Timothy I. Morgenthaler, MD, president of the American Academy of Sleep Medicine, professor of medicine at the Mayo Clinic – Rochester comments “High blood pressure hat is resistant to treatment with medications is a strong warning sign for the presence of obstructive sleep apnea, a chronic disease that increases the risk for heart disease and stroke.” "Over one-third of patients with hypertension and nearly eight out of 10 patients with treatment resistant hypertension have obstructive sleep apnea. People who have high blood pressure should talk to a doctor about their risk for sleep apnea."
According to the CDC 67 million American adults have high blood pressure and only half of the people with high blood pressure have their condition under control.
The Sound Sleep Institute reports that 83% with drug-resistant high blood pressure have obstructive sleep apnea.
Being over 45 for males and over 55 for females increases your risk of high blood pressure, as does a poor diet with high salt content, in addition to lack of exercise, genetics, smoking, racial factors, high cholesterol, diabetes, alcohol and sleep apnea.
This study appears in the Journal of Clinical Sleep Medicine