Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy
Background Obstructive sleep apnoea (OSA) is strongly associated with systemic hypertension, but there are limited data on the relationship with blood pressure (BP) in normotensive subjects. Here, we examined the relationship of OSA with nocturnal BP in a documented diurnal normotensive cohort, expl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2021-08-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/7/3/00338-2021.full |
| _version_ | 1818587601820450816 |
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| author | Sophie J. Crinion Jana Kleinerova Brian Kent Geraldine Nolan Cormac T. Taylor Silke Ryan Walter T. McNicholas |
| author_facet | Sophie J. Crinion Jana Kleinerova Brian Kent Geraldine Nolan Cormac T. Taylor Silke Ryan Walter T. McNicholas |
| author_sort | Sophie J. Crinion |
| collection | DOAJ |
| description | Background
Obstructive sleep apnoea (OSA) is strongly associated with systemic hypertension, but there are limited data on the relationship with blood pressure (BP) in normotensive subjects. Here, we examined the relationship of OSA with nocturnal BP in a documented diurnal normotensive cohort, explored potential intermediate pathways and assessed the effects on BP of continuous positive airways pressure (CPAP) therapy.
Methods
65 males referred for assessment of possible OSA and normotensive on 24-hour BP monitoring underwent overnight inpatient polysomnography (age 41±7 years, body mass index (BMI) 34±6 kg·m−2, apnoea–hypopnoea index (AHI) 14 (interquartile range 5–26)). Urine and serum were assessed for markers of sympathetic activation, renin–angiotensin–aldosterone system activity, oxidative stress, endothelial function and systemic inflammation. In a subset of patients, 24-hour BP monitoring was repeated after CPAP therapy.
Results
Within this normotensive cohort, night-time systolic and diastolic BP and nocturnal BP dip were highest in the fourth OSA severity quartile (p<0.05). Nocturnal BP dip correlated with AHI (r=−0.327, p<0.05) and oxygen desaturation index (ODI) (r=−0.371, p<0.05), but only ODI was an independent predictor of BP dip (B=–0.351, p<0.01) and non-dipping status (B=0.046, p<0.05). Overnight urinary norepinephrine correlated with nocturnal systolic BP (r=0.387, p<0.01) with a trend towards correlation with systolic dipping (p=0.087). In 20 CPAP-treated patients, night-time systolic BP decreased (p<0.05) and mean nocturnal BP dip increased (p≤0.05).
Conclusion
In this normotensive cohort, OSA severity was associated with higher nocturnal BP, which improved following CPAP therapy, and intermittent hypoxia was the most important OSA-related variable in this relationship. |
| first_indexed | 2024-12-16T09:11:27Z |
| format | Article |
| id | doaj.art-36b68107a5004d3ab3c67fe1020f54c9 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-16T09:11:27Z |
| publishDate | 2021-08-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-36b68107a5004d3ab3c67fe1020f54c92022-12-21T22:36:58ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-08-017310.1183/23120541.00338-202100338-2021Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapySophie J. Crinion0Jana Kleinerova1Brian Kent2Geraldine Nolan3Cormac T. Taylor4Silke Ryan5Walter T. McNicholas6 Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, Canada Dept of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland Dept of Respiratory Medicine, St James’ Hospital, Dublin, Ireland Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, Ireland Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland Background Obstructive sleep apnoea (OSA) is strongly associated with systemic hypertension, but there are limited data on the relationship with blood pressure (BP) in normotensive subjects. Here, we examined the relationship of OSA with nocturnal BP in a documented diurnal normotensive cohort, explored potential intermediate pathways and assessed the effects on BP of continuous positive airways pressure (CPAP) therapy. Methods 65 males referred for assessment of possible OSA and normotensive on 24-hour BP monitoring underwent overnight inpatient polysomnography (age 41±7 years, body mass index (BMI) 34±6 kg·m−2, apnoea–hypopnoea index (AHI) 14 (interquartile range 5–26)). Urine and serum were assessed for markers of sympathetic activation, renin–angiotensin–aldosterone system activity, oxidative stress, endothelial function and systemic inflammation. In a subset of patients, 24-hour BP monitoring was repeated after CPAP therapy. Results Within this normotensive cohort, night-time systolic and diastolic BP and nocturnal BP dip were highest in the fourth OSA severity quartile (p<0.05). Nocturnal BP dip correlated with AHI (r=−0.327, p<0.05) and oxygen desaturation index (ODI) (r=−0.371, p<0.05), but only ODI was an independent predictor of BP dip (B=–0.351, p<0.01) and non-dipping status (B=0.046, p<0.05). Overnight urinary norepinephrine correlated with nocturnal systolic BP (r=0.387, p<0.01) with a trend towards correlation with systolic dipping (p=0.087). In 20 CPAP-treated patients, night-time systolic BP decreased (p<0.05) and mean nocturnal BP dip increased (p≤0.05). Conclusion In this normotensive cohort, OSA severity was associated with higher nocturnal BP, which improved following CPAP therapy, and intermittent hypoxia was the most important OSA-related variable in this relationship.http://openres.ersjournals.com/content/7/3/00338-2021.full |
| spellingShingle | Sophie J. Crinion Jana Kleinerova Brian Kent Geraldine Nolan Cormac T. Taylor Silke Ryan Walter T. McNicholas Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy ERJ Open Research |
| title | Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| title_full | Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| title_fullStr | Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| title_full_unstemmed | Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| title_short | Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| title_sort | non dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy |
| url | http://openres.ersjournals.com/content/7/3/00338-2021.full |
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