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      Obstructive sleep apnea and hypertension; critical overview

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          Abstract

          Obstructive sleep apnea (OSA) and hypertension are two important modifiable risk factors for cardiovascular disease and mortality. Numerous studies have highlighted the interplay between these two conditions. We provide a critical review of the current literature on the role of the OSA as a risk factor for hypertension and its effect on blood pressure (BP). We discuss several key topics: the effect of OSA on nocturnal BP, BP response to continuous positive airway pressure (CPAP) treatment, CPAP effect on BP in refractory hypertension, the role of OSA in BP variability (BPV), and maladaptive cardiac remodeling mediated by OSA’s effect on BP. Finally, we discuss the unique aspects of ethnicity and social determinants of health on OSA with a focus on Asian populations and the disparity in BP control and cardiovascular outcomes.

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          Most cited references103

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          Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries.

          Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010.
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            Prospective study of the association between sleep-disordered breathing and hypertension.

            Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the association between objectively measured sleep-disordered breathing and hypertension (defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications). We analyzed data on sleep-disordered breathing, blood pressure, habitus, and health history at base line and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study (and after eight years of follow-up in the case of 184 of these participants). Participants were assessed overnight by 18-channel polysomnography for sleep-disordered breathing, as defined by the apnea-hypopnea index (the number of episodes of apnea and hypopnea per hour of sleep). The odds ratios for the presence of hypertension at the four-year follow-up study according to the apnea-hypopnea index at base line were estimated after adjustment for base-line hypertension status, body-mass index, neck and waist circumference, age, sex, and weekly use of alcohol and cigarettes. Relative to the reference category of an apnea-hypopnea index of 0 events per hour at base line, the odds ratios for the presence of hypertension at follow-up were 1.42 (95 percent confidence interval, 1.13 to 1.78) with an apnea-hypopnea index of 0.1 to 4.9 events per hour at base line as compared with none, 2.03 (95 percent confidence interval, 1.29 to 3.17) with an apnea-hypopnea index of 5.0 to 14.9 events per hour, and 2.89 (95 percent confidence interval, 1.46 to 5.64) with an apnea-hypopnea index of 15.0 or more events per hour. We found a dose-response association between sleep-disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors. The findings suggest that sleep-disordered breathing is likely to be a risk factor for hypertension and consequent cardiovascular morbidity in the general population.
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              Increased prevalence of sleep-disordered breathing in adults.

              Sleep-disordered breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-disordered breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-disordered breathing prevalence require updating. We estimated the prevalence of sleep-disordered breathing in the United States for the periods of 1988-1994 and 2007-2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30-70 years of age had baseline polysomnography studies to assess the presence of sleep-disordered breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-disordered breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-disordered breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30-49-year-old men; 17% (95% CI: 15, 21) among 50-70-year-old men; 3% (95% CI: 2, 4) among 30-49-year-old women; and 9% (95% CI: 7, 11) among 50-70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).
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                Author and article information

                Contributors
                yhkwon@uw.edu
                GRHONG@yuhs.ac
                Journal
                Clin Hypertens
                Clin Hypertens
                Clinical Hypertension
                BioMed Central (London )
                2056-5909
                1 August 2024
                1 August 2024
                2024
                : 30
                : 19
                Affiliations
                [1 ]Department of Medicine, University of Washington, ( https://ror.org/00cvxb145) Seattle, WA USA
                [2 ]Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, ( https://ror.org/01wjejq96) 50–1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722 Republic of Korea
                [3 ]Department of Acute & Specialty Care, University of Virginia School of Nursing, ( https://ror.org/0153tk833) Charlottesville, VA USA
                [4 ]Klinik Für Innere Medizin II, Universitätsklinikum Ulm, ( https://ror.org/05emabm63) Ulm, Germany
                [5 ]Department of Medicine, Hualien Armed Forces General Hospital, ( https://ror.org/00ggmjy78) Hualien, Taiwan
                [6 ]GRID grid.260565.2, ISNI 0000 0004 0634 0356, Department of Medicine, Tri-Service General Hospital, , National Defense Medical Center, ; Taipei, Taiwan
                [7 ]GRID grid.84393.35, ISNI 0000 0001 0360 9602, Department of Pneumology, , Polytechnic and University La Fe Hospital, ; Valencia, Spain
                [8 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, Department of Medicine and Surgery, , University of Milano-Bicocca, ; Milan, Italy
                [9 ]Department of Cardiology, Istituto Auxologico Italiano IRCCS, S.Luca Hospital, ( https://ror.org/033qpss18) Milan, Italy
                [10 ]Johns Hopkins School of Nursing, Johns Hopkins University, ( https://ror.org/00za53h95) Baltimore, MD USA
                [11 ]Department of Sleep Medicine, University of Washington, ( https://ror.org/00cvxb145) Seattle, WA USA
                [12 ]GRID grid.267047.0, ISNI 0000 0001 2105 7936, Department of Sleep Medicine, , Veteran’s Affairs Puget Sound Healthcare System, ; Seattle, WA USA
                [13 ]Hypertension Unit, Heart Institute, University of Sao Paulo Medical School, ( https://ror.org/036rp1748) Sao Paulo, Brazil
                [14 ]GRID grid.410427.4, ISNI 0000 0001 2284 9329, Division of Pulmonary, Critical Care, Sleep Medicine, , Medical College of Georgia, ; Augusta, GA USA
                [15 ]Division of Cardiology, University of Washington, ( https://ror.org/00cvxb145) Seattle, WA USA
                Author information
                http://orcid.org/0000-0003-4981-3304
                Article
                276
                10.1186/s40885-024-00276-7
                11293186
                39090691
                d1302360-1555-464a-8dbd-c1931b07bad5
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 January 2024
                : 22 May 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100020273, Korean Society of Hypertension;
                Award ID: KSH-2010
                Award Recipient :
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                © The Korean Society of Hypertension 2024

                obstructive sleep apnea,continuous positive airway pressure,hypertension,blood pressure

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