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      Among middle-aged adults, snoring predicted hypertension independently of sleep apnoea

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          Abstract

          Objective

          While the link between obstructive sleep apnoea (OSA) and hypertension is well established, the relationships between snoring, OSA, and hypertension remain unclear. This study aimed to evaluate the association between hypertension and snoring independently of OSA.

          Methods

          Adults with sleep difficulties underwent a one-night polysomnographic sleep assessment, including a thorough assessment of apnoea and snoring. Upon waking, blood pressure was measured, the measurement repeated after 15 min, in a resting position. Anthropometric data were recorded. Hypertension was defined as blood pressure ≥140/90 mmHg or the use of antihypertensive medications.

          Results

          The study enrolled 181 adults (mean age 48.8 years; 119 males). Snoring, apnoea, blood pressure and anthropometric dimensions were highly associated. Patients with hypertension had higher levels of snoring and apnoea, as well as indicators of excess weight. Snoring was the most robust predictor of hypertension.

          Conclusions

          Snoring is a risk factor for hypertension independently of apnoea and anthropometric dimensions. While the presence of snoring is not able to replace a thorough polysomnographic evaluation of the apnoea-hypopnoea index and OSA, snoring as an acoustic signal is easily detectable. The early identification and management of snoring may reduce cardiovascular risk.

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          Most cited references31

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          Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea.

          The prevalence of obstructive sleep apnea (OSA) defined at an apnea-hypopnea index (AHI) ≥5 was a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women in eleven published epidemiological studies published between 1993 and 2013. OSA with excessive daytime sleepiness occurred in 6% (range, 3-18%) of men and in 4% (range, 1-17%) of women. The prevalence increased with time and OSA was reported in 37% of men and in 50% of women in studies from 2008 and 2013 respectively. OSA is more prevalent in men than in women and increases with age and obesity. Smoking and alcohol consumption are also suggested as risk factors, but the results are conflicting. Excessive daytime sleepiness is suggested as the most important symptom of OSA, but only a fraction of subjects with AHI >5 report daytime sleepiness and one study did not find any relationship between daytime sleepiness and sleep apnea in women. Stroke and hypertension and coronary artery disease are associated with sleep apnea. Cross-sectional studies indicate an association between OSA and diabetes mellitus. Patients younger than 70 years run an increased risk of early death if they suffer from OSA. It is concluded that OSA is highly prevalent in the population. It is related to age and obesity. Only a part of subjects with OSA in the population have symptoms of daytime sleepiness. The prevalence of OSA has increased in epidemiological studies over time. Differences and the increase in prevalence of sleep apnea are probably due to different diagnostic equipment, definitions, study design and characteristics of included subjects including effects of the obesity epidemic. Cardiovascular disease, especially stroke is related to OSA, and subjects under the age of 70 run an increased risk of early death if they suffer from OSA.
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            Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea.

            Sleepiness is a key symptom in obstructive sleep apnea syndrome (OSAS) and can be objectively assessed with a multiple sleep latency test (MSLT). We studied the terms that patients prefer to describe their symptoms-sleepiness, fatigue, tiredness, or lack of energy-and how these terms relate to objective findings. Observational. University-based sleep laboratory. Consecutive OSAS patients referred for diagnostic polysomnography and an MSLT. Data were obtained from sleep studies and questionnaires. Subjects included 117 men and 73 women, with a mean (+/- SD) age of 49 +/- 13 years, an apnea and hypopnea rate of 32 +/- 28/h of sleep, and an MSLT mean sleep latency of 7 +/- 5 min. Subjects more frequently reported problems with fatigue, tiredness, and lack of energy than sleepiness (57%, 61%, and 62% vs 47%). When required to select the one most significant symptom, more patients chose lack of energy (about 40%) than any other problem, including sleepiness (about 22%). Objective measures of sleepiness and apnea severity showed little or no association with any symptom, but female gender showed significant associations with each. Complaints of fatigue, tiredness, or lack of energy may be as important as that of sleepiness to OSAS patients, among whom women appear to have all such complaints more frequently than men. The diagnosis of OSAS should not be excluded based only on a person's tendency to emphasize fatigue, tiredness, or lack of energy more than sleepiness.
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              Testing for Serial Correlation in Least Squares Regression. III

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                Author and article information

                Journal
                J Int Med Res
                J. Int. Med. Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                11 January 2018
                March 2018
                : 46
                : 3
                : 1187-1196
                Affiliations
                [1 ]Sleep Disorders Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
                [2 ]Psychiatric Clinics, Centre for Affective, Stress and Sleep Disorders, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
                [3 ]Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, University of Basel, Basel, Switzerland
                Author notes
                [*]Serge Brand, Psychiatric Clinics (UPK), Centre for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Email: serge.brand@ 123456upkbs.ch
                Author information
                http://orcid.org/0000-0003-2175-2765
                Article
                10.1177_0300060517738426
                10.1177/0300060517738426
                5972254
                29322844
                8b9c918e-1680-443a-ba49-244485157d4f
                © The Author(s) 2018

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 July 2017
                : 2 October 2017
                Categories
                Clinical Reports

                snoring,sleep apnoea,cardiovascular disease,blood pressure

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