Key result
OSA links to ~23% higher hypertension risk in obese patients while diurnal hypoventilation predicts heart failure.
Why the study?
Obesity and OSA are risk factors for HT and CHF, with overlap syndrome and OHS proposed to increase cardiovascular risk.
Are obstructive sleep apnea and diurnal hypoventilation independent determinants of hypertension and cardiac failure in obese patients?
Are obstructive sleep apnea and diurnal hypoventilation independent determinants of hypertension and cardiac failure in obese patients?
In obese patients suspected of having sleep apnea, OSA is independently associated with hypertension, while diurnal hypoventilation is highly predictive of cardiac failure.
May warrant targeted screening for OSA in obese hypertensives and diurnal hypoventilation in those with HF; extends cohort evidence in this high-risk group.
Rationale: Both obesity and obstructive sleep apnea (OSA) are risk factors for hypertension (HT) and chronic heart failure (CHF). The association between OSA and COPD (overlap syndrome) and the obesity hypoventilation syndrome (OHS) have been proposed as leading to enhanced cardiovascular risk. Methods: 3093 obese subjects (IMC>30kg/m 2 ) referred for suspicion of OSA were prospectively assessed by sleep studies, lung function tests and blood gazes. For the whole group, mean age was 57±13 years with 66% of men, mean BMI: 36.8±6.2 kg/m 2 , 52.8% of the subjects being hypertensive and 3.23% suffering from CHF. 926 of the 3093 did not exhibit OSA or COPD. Results: In multivariate analysis, prevalent hypertension was associated with OSA (Odd ratio (OR): 1.23 (confidence intervals (CI): 1.04-1.45), p=0.015), ≥2 nocturia episodes per night (OR: 1.295 (CI: 1.10-1.52), p<0.01), type 2 diabetes (OR: 2.12 (CI: 1.56-2.88), p<0.01), hypercholesterolemia (OR: 1.94 (CI: 1.6-2.34), p<0.01), reduced physical activity (OR: 1.25 (CI: 1.04-1.49), p<0.01), each one unit increase in BMI increase (OR: 1.025 (CI: 1.01-1.04), p<0.01), each one unit increase in age (OR: 1.06 (CI: 1.04-1.07), p<0.01). In multivariate analysis, cardiac failure was explained by diurnal hypoventilation (OR: 2.64 (CI: 1.67-4.29), p<0.01), reduced physical activity (OR: 3.73 (CI: 2.44-5.7), p<0.01), former smoking (OR: 1.63 (CI: 1.06-2.51), p=0.025), and each one unit increase in age (OR: 1.07 (CI: 1.03-1.11), p<0.01). Conclusions: Sleep apnea was linked with HT independently of other classical cardiovascular risk factors. Diurnal hypoventilation was highly predictive of cardiac failure.
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Pepin et al. (2011) studied this question. Obstructive sleep apnea was independently associated with hypertension (OR: 1.23) in obese patients, while diurnal hypoventilation was predictive of cardiac failure (OR: 2.64).
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