Key result
Untreated moderate-to-severe OSA linked to ~191% higher risk of hypertensive crises versus controls.
Why the study?
Hypertensive crises are not usually included in studies on the relationship between obstructive sleep apnea and cardiovascular diseases, creating uncertainty about their association and the role of CPAP treatment.
Does CPAP treatment reduce the incidence of hypertensive crisis in patients with moderate-to-severe obstructive sleep apnea compared to untreated patients?
Cohort (n=1,021)
Does CPAP treatment reduce the incidence of hypertensive crisis in patients with moderate-to-severe obstructive sleep apnea compared to untreated patients?
Hazard Ratio: 2.91 (95% CI 1.97–5.78)
Absolute Event Rate: 14.46% vs 1.75%
p-value: p=< 0.001
In patients with moderate-to-severe OSA, untreated disease significantly increases the risk of hypertensive crises, while good adherence to CPAP therapy reduces this risk to levels comparable to patients without OSA.
May prompt OSA screening after hypertensive crises; leaves open whether CPAP prevents events in randomized settings.
STUDY OBJECTIVES: Hypertensive crises (HC) are not usually included in studies on the relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. Consequently, our objective is to analyze the relationship between untreated OSA, treatment with CPAP and the incidence of HC. METHODS: Prospective study of 1,021 individuals recruited for clinical suspicion of OSA. Sleep parameters, medical history and HC were recorded during follow-up. HC was considered by the presence of SBP/DBP > 180/110 mmHg respectively in patients with compatible symptoms or damage of a target organ. Subjects were divided into three groups: (a) AHI ≤ 15;n = 401 (control group), (b) OSA treated with CPAP with good adherence; n = 362, and (c) AHI > 15 events/h with initial refusal of or non-compliance with CPAP treatment, n = 249. RESULTS: In the median follow up (16 [IQR: 13.7-17.8]) months, there were 58 incident HC events (7 the non-OSA group, 15 in the OSA group with good tolerance to CPAP, and 36 in the moderate-severe OSA group without/poor adherence to CPAP. Forty-six had arterial hypertension. In the survival analysis, those patients with moderate-to-severe OSA without CPAP had a fully adjusted risk of 2.91 (95%CI: 1.97-5.78; p < 0.001), with the CPAP-treated group showing no evidence of increased HC risk (HR 1.12; p:NS) compared to the control group. Among hypertensive subjects, the relationship between moderate-to-severe untreated OSA and the risk of HC was greatly enhanced: HR 7.22 (CI: 2.81-12.5; p < 0.001). CONCLUSIONS: Untreated/non adherent to CPAP patients with moderate-to-severe OSA are at significantly higher risk of incident HC, particularly if they suffer from hypertension. Treatment with CPAP has a favorable effect by reduces the HC risk to control levels.
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Oscullo et al. (2025) conducted a cohort in Clinical suspicion of obstructive sleep apnea (n=1,021). Untreated moderate-to-severe obstructive sleep apnea vs. AHI ≤ 15 (control group) was evaluated on Incident hypertensive crises (HC) (HR 2.91, 95% CI 1.97-5.78, p=< 0.001). Untreated moderate-to-severe obstructive sleep apnea significantly increased the risk of incident hypertensive crises compared to controls (HR 2.91; 95% CI 1.97-5.78; p < 0.001).
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