Effect of Hypertension on Left Ventricular Diastolic Dysfunction Associated with Obstructive Sleep Apnea

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obstructive Sleep Apnea and Hypertension (n=289). Intervention: Hypertension and Obstructive Sleep Apnea vs. Healthy controls or unexposed groups. Primary outcome: Left ventricular diastolic dysfunction (E/e' ratio) (MD -1.784, 95% CI -2.868 to -0.701, p=0.001).

Q: What does this research mean for the field?

Hypertension independently impairs left ventricular diastolic function and exhibits a synergistic interaction with obstructive sleep apnea severity to worsen diastolic impairment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jia-Le Chen; Shuhan Chen; Wei-ze Lin; Ruo-Ying Chen; Wanqi Li; Ping-yu Cai; Hui-li Lin

doi:10.2147/nss.s586614

August 1, 2026Nature and Science of SleepOpen Access

Effect of Hypertension on Left Ventricular Diastolic Dysfunction Associated with Obstructive Sleep Apnea

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Key result

Hypertension independently impaired left ventricular diastolic function (E/e' ratio mean difference -1.784) and demonstrated a significant synergistic interaction with obstructive sleep apnea severity.

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Why the study?

The effect of hypertension on obstructive sleep apnea-related left ventricular diastolic dysfunction remains unclear.

Does the coexistence of hypertension and obstructive sleep apnea synergistically worsen echocardiographic markers of left ventricular diastolic dysfunction compared to either condition alone?

Key Points

To determine the independent and interactive effects of hypertension and obstructive sleep apnea severity on left ventricular diastolic dysfunction.
Enrolled 289 participants categorized into healthy controls (n=54), hypertension only (n=62), obstructive sleep apnea only (n=79), and comorbid obstructive sleep apnea with hypertension (n=94).
Evaluated patients using polysomnography, laboratory biochemistry, and echocardiography to assess diastolic markers including IVST, LVPW, LAVI, E/A ratio, and E/e' ratio.
Left ventricular diastolic parameters (IVST, LVPW, LAVI, and E/e' ratio) were significantly elevated in the HTN, OSA, and OSA-HTN groups compared with healthy controls (p<0.05), with the greatest impairment in the OSA-HTN group.
Hypertension (mean difference=-1.784, 95% CI: -2.868 to -0.701, p=0.001) and OSA severity independently affected the E/e' ratio, with a persistent multiplicative interaction after adjusting for age and BMI (p=0.037).
Multivariate regression revealed that systolic blood pressure (B=0.037; 95% CI: 0.022–0.052; p<0.001), diastolic blood pressure (B=0.040; 95% CI: 0.019–0.062; p<0.001), and AHI (B=0.109; 95% CI: 0.085–0.134; p<0.001) were independent predictors of the E/e' ratio.

Study Design

Type

Cross-Sectional (n=289)

Multicenter

No

Structured PICO

Does the coexistence of hypertension and obstructive sleep apnea synergistically worsen echocardiographic markers of left ventricular diastolic dysfunction compared to either condition alone?

P

Population

289 participants (mean age 47.3, 20.1% female) classified by hypertension and obstructive sleep apnea severity to evaluate their independent and combined effects on left ventricular diastolic function.

O

Outcome

Left ventricular diastolic function parameters measured by echocardiography, primarily the E/e' ratio, along with interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPW), left atrial volume index (LAVI), and E/A ratiosurrogate

Main Result

Mean Difference: -1.784 (95% CI -2.868–-0.701)

p-value: p=0.001

Limitations

Cross-sectional study design prevents establishing causality
All subjects were recruited from a single medical center
Use of medications such as antihypertensive drugs was not systematically controlled
OSA severity was only described by AHI, without reporting parameters related to hypoxemia
Lack of assessment of right ventricular dysfunction and pulmonary hypertension
Cross-sectional design limits the ability to establish causality.
Single-center recruitment limits generalizability.
Use of medications, such as antihypertensive drugs, was not systematically controlled, which could have influenced the results and introduced confounding bias.
The severity of obstructive sleep apnea is described only by AHI, without reporting parameters related to hypoxemia.
Lack of assessment of right ventricular dysfunction and pulmonary hypertension.

Implication

Supports targeted diastolic assessment in comorbid hypertension and OSA; hypothesis-generating and requires prospective validation before practice change.

Abstract

Purpose: Obstructive sleep apnea (OSA) and hypertension are known cardiovascular risk factors, but the effect of hypertension on OSA-related left ventricular diastolic dysfunction remains unclear. Patients and Methods: This cross-sectional study enrolled 289 patients from the Second Affiliated Hospital of Fujian Medical University (January 2013-January 2023). Participants were classified as healthy controls (HC), OSA-only (OSA), hypertension only (HTN), and OSA with hypertension (OSA-HTN). Furthermore, based on the AHI (Apnea-Hypopnea Index) values, the OSA group and the OSA-HTN group were further divided into three subgroups: mild (5≤AHI<15 events/hour), moderate (15≤AHI<30 events/hour), and (AHI≥30 events/hour). Participants underwent biochemical testing, echocardiography, and polysomnography. Echocardiographic parameters of diastolic function-interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPW), left atrial volume index (LAVI), E/A ratio, and E/e' ratio-were compared among the groups. One-way analysis of variance and statistical interaction analysis evaluated the independent and interactive effects of hypertension and OSA severity on E/e'. Results: Compared with the HC group, the HTN, OSA, and OSA-HTN groups showed significantly higher IVST, LVPW, LAVI, and E/e' ratio (p<0.05), with the OSA-HTN group exhibiting the greatest impairment. The E/e' ratio increased with OSA severity and correlated positively with systolic blood pressure and diastolic blood pressure, most strongly in the OSA-HTN group. Hypertension (mean difference=-1.784, 95% CI: -2.868 to -0.701, p=0.001) and OSA severity independently affected E/e' with a significant multiplicative interaction (p<0.05). Conclusion: Both hypertension and severe obstructive sleep apnea are independently associated with impaired left ventricular diastolic function, and their coexistence may have a potential synergistic effect.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cross-sectional in Obstructive Sleep Apnea and Hypertension (n=289). Hypertension and Obstructive Sleep Apnea vs. Healthy controls or unexposed groups was evaluated on Left ventricular diastolic dysfunction (E/e' ratio) (MD -1.784, 95% CI -2.868 to -0.701, p=0.001). Hypertension independently impaired left ventricular diastolic function (E/e' ratio mean difference -1.784) and demonstrated a significant synergistic interaction with obstructive sleep apnea severity.

synapsesocial.com/papers/6ad0fcc53afa093ea9acff98 https://doi.org/10.2147/nss.s586614

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Effect of Hypertension on Left Ventricular Diastolic Dysfunction Associated with Obstructive Sleep Apnea

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Effect of Hypertension on Left Ventricular Diastolic Dysfunction Associated with Obstructive Sleep Apnea

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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