Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
West Virginia University School of Medicine, Morgantown, WV.
J Hypertens. 2012 May;30(5):960-966. doi: 10.1097/HJH.0b013e328351d08a.
To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD).
We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90 mmHg despite at least three antihypertensive drugs.
Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2 mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix.
The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.
探讨阻塞性睡眠呼吸暂停（OSA）与慢性肾脏病（CKD）和终末期肾病（ESRD）患者中难治性高血压的关系。
我们检查了睡眠参数和血压（BP）在 224 名社区非 CKD 参与者的 Sleep-SCORE 研究中：88 名非透析依赖性 CKD 和 95 名 ESRD 参与者。使用未经监督的家庭多导睡眠图和标准化评分方案以及自动血压监测仪。难治性高血压定义为至少使用三种降压药物后血压仍至少为 140/90mmHg。
CKD 和 ESRD 组的平均 SBP 明显高于非 CKD 组[148.2（23.8），144.5（26.7）与 132.2mmHg（26.7），分别; P<0.0001]尽管使用了更多的降压药物。CKD 和 ESRD 组的难治性高血压发生率高于非 CKD 组（分别为 41.4％，22.6％与 6.7％; P<0.0001）。睡眠呼吸暂停的严重程度与难治性高血压的风险增加有关。尽管在 ESRD 患者中，难治性高血压与严重的睡眠呼吸暂停相关（比值比[OR]7.1，95％置信区间[CI]2.2-23.2），但在非 CKD（OR 3.5，95％CI 0.8-15.4）或 CKD 组中没有显着关联（OR 1.2，95％CI 0.4-3.7），在考虑病例组合后。
在 ESRD 中，难治性高血压与睡眠呼吸暂停之间的关联似乎很强。OSA 可能导致难治性高血压，或者两者可能与体积过多等共同的潜在过程有关。未来在肾脏病患者中的研究应进一步描述难治性高血压与 OSA 的关系，并确定治疗潜在机制是否可以改善结局。
