A review on obstructive sleep apnea (OSA) and its relationship with cardiovascular disease (CVD) has been published in the prestigious journal “Circulation”. In this post, we relate what has been published regarding the association with OSA and arterial hypertension (AHT).
- OSA is very prevalent in hypertensive patients: it is estimated that between 30% and 50% present OSA.
- It is more common in patients with resistant HT: it is possible that up to 80% of resistant hypertensive patients may have OSA.
- Treatment with continuous positive airway pressure (CPAP) on blood pressure (BP) reduction has not demonstrated considerable reductions in blood pressure: a meta-analysis showed BP reductions of between 2 and 3 mmHg, although compliance with CPAP is associated with greater reductions in nocturnal BP.
- HT is not a consequence of OSA, although it is true that both OSA and HT have multifactorial causes and often coexist.
Therapies other than CPAP are also considered in patients with OSAH
- Treatments with oral appliances (soft palate elevators, tongue retaining devices, mandibular advancement devices), BP reduction was similar to that observed in the meta-analysis of CPAP trials (2-3 mmHg).
- Uvulopalatopharyngoplasty may be beneficial in selected patients, with significant decreases of 4 to 9 mmHg reported at 6 and 24 months after surgery in a small randomized controlled trial.
- Spironolactone, in a small randomized controlled trial, reduced the severity of OSA and lowered BP in patients with resistant HT.
- Renal denervation, in a study of 60 patients with resistant HT and moderate to severe OSA, significantly reduced BP at 3 and 6 months after the intervention, with modest reductions in OSA severity.
In fact, 34% of middle-aged men and 17% of middle-aged women are considered to meet the diagnostic criteria for OSA, but this entity is highly underdiagnosed, so we should place more emphasis on its diagnosis, especially in hypertensive individuals.