Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA (D.A.J., N.G., M.R., S.R.).
Division of Sleep Medicine, Harvard Medical School, Boston, MA (D.A.J., S.R.).
Circulation. 2019 Mar 5;139(10):1275-1284. doi: 10.1161/CIRCULATIONAHA.118.036675.
Blacks have a high prevalence of hypertension and uncontrolled blood pressure (BP), each of which may be partially explained by untreated sleep apnea. We investigated the association of sleep apnea with uncontrolled BP and resistant hypertension in blacks.
Between 2012 and 2016, Jackson Heart Sleep Study participants (N=913) underwent an in-home Type 3 sleep apnea study, clinic BP measurements, and anthropometry. Moderate or severe obstructive sleep apnea (OSA) was defined as a respiratory event index ≥15, and nocturnal hypoxemia was quantified as percent sleep time with <90% oxyhemoglobin saturation. Prevalent hypertension was defined as either a systolic BP ≥130 mm Hg or diastolic BP >80mm Hg, use of antihypertensive medication, or self-report of a diagnosis of hypertension. Controlled BP was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg; uncontrolled BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with use of 1 to 2 classes of antihypertensive medication; and resistant BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with the use of ≥3 classes of antihypertensive medication (including a diuretic) or use of ≥4 classes of antihypertensive medication regardless of BP level. Multinomial logistic regression models were fit to determine the association between OSA severity and uncontrolled BP or resistant hypertension (versus controlled BP) after multivariable adjustment.
The analytic sample with hypertension (N=664) had a mean age of 64.0 (SD,10.6) years, and were predominately female (69.1%), obese (58.6%), and college educated (51.3%). Among the sample, 25.7% had OSA, which was untreated in 94% of participants. Overall, 48% of participants had uncontrolled hypertension and 14% had resistant hypertension. After adjustment for confounders, participants with moderate or severe OSA had a 2.0 times higher odds of resistant hypertension (95% confidence interval [CI], 1.14-3.67). Each standard deviation higher than <90% oxyhemoglobin saturation was associated with an adjusted odds ratio for resistant hypertension of 1.25 (95% CI 1.01-1.55). OSA and <90% oxyhemoglobin saturation were not associated with uncontrolled BP.
Untreated moderate or severe OSA is associated with increased odds of resistant hypertension. These results suggest that untreated OSA may contribute to inadequate BP control in blacks.
黑人高血压和血压控制不佳的患病率较高，其中每一种情况都可能部分归因于未经治疗的睡眠呼吸暂停。我们研究了睡眠呼吸暂停与黑人血压控制不佳和耐药性高血压之间的关系。
在 2012 年至 2016 年期间，杰克逊心脏睡眠研究参与者（N=913）接受了家庭 3 型睡眠呼吸暂停研究、诊所血压测量和人体测量。中度或重度阻塞性睡眠呼吸暂停（OSA）定义为呼吸事件指数≥15，夜间低氧血症定义为睡眠时间百分比<90%氧合血红蛋白饱和度。高血压的患病率定义为收缩压≥130mmHg 或舒张压>80mmHg、使用降压药物或自我报告高血压诊断。血压控制定义为收缩压<130mmHg 和舒张压<80mmHg；血压控制不佳定义为收缩压≥130mmHg 或舒张压≥80mmHg，使用 1 至 2 类降压药物；耐药性血压定义为收缩压≥130mmHg 或舒张压≥80mmHg，使用≥3 类降压药物（包括利尿剂）或使用≥4 类降压药物，无论血压水平如何。多变量逻辑回归模型用于确定 OSA 严重程度与血压控制不佳或耐药性高血压（与血压控制良好相比）之间的关联，调整后进行多变量调整。
患有高血压的分析样本（N=664）的平均年龄为 64.0（标准差，10.6）岁，主要为女性（69.1%）、肥胖（58.6%）和大学学历（51.3%）。在样本中，25.7%的人患有 OSA，其中 94%的参与者未接受治疗。总体而言，48%的参与者血压控制不佳，14%的参与者耐药性高血压。调整混杂因素后，中度或重度 OSA 患者耐药性高血压的几率增加 2.0 倍（95%置信区间 [CI]，1.14-3.67）。每高于<90%氧合血红蛋白饱和度一个标准差，与耐药性高血压的调整后比值比相关为 1.25（95%CI 1.01-1.55）。OSA 和<90%氧合血红蛋白饱和度与血压控制不佳无关。
未经治疗的中重度 OSA 与耐药性高血压的几率增加有关。这些结果表明，未经治疗的 OSA 可能导致黑人血压控制不足。
