Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro.
Department of Specialized Medicine, Cardiology Section - School of Medicine, Universidade Federal do Estado do Rio de Janeiro.
J Hypertens. 2022 Jul 1;40(7):1327-1335. doi: 10.1097/HJH.0000000000003144.
Refractory hypertension (RfHT) and obstructive sleep apnea (OSA) share common pathophysiological mechanisms and probably are intrinsically associated, but their prevalence, clinical profile, and polysomnography (PSG) pattern remain misunderstood.
To describe OSA prevalence and PSG pattern of patients with RfHT in a large cohort of resistant hypertension (RHT).
This is a cross-sectional study involving 418 RHT patients (30.9% male; mean age of 62.5 ± 9.9 years) who were submitted to full-night PSG. RfHT was defined as uncontrolled ambulatory blood pressure monitoring using five or more antihypertensive drugs, including spironolactone. Bivariate analysis compared RHT and RfHT and multivariate analysis was performed to assess the independent correlates of OSA.
A total of 90 patients (21.5%) were diagnosed with RfHT (26.7% male; mean age of 58.5 ± 8.3 years). In comparison with resistant ones, RfHT patients were younger, with higher smoking and previous cardiovascular diseases prevalence, especially stroke. There was no difference regarding anthropometric measures. OSA prevalence (80.0 vs. 82.9%) and moderate/severe OSA (51.1 vs. 57.0%) were similar in both groups as well as apnea-hypopnea index. In its turn, refractory hypertensive patients presented better sleep efficiency (78 vs. 71%), with higher total sleep time (315 vs. 281 min) and lower sleep latency (11 vs. 17 min). There was no difference regarding rapid eye movement sleep, oxygen saturation, microarousals index, and periodic limb movement.
In this large RHT cohort, resistant and refractory hypertensive patients have similar OSA prevalence, although refractory ones, which by definition use spironolactone, are younger and apparently have a better sleep pattern.
难治性高血压（RfHT）和阻塞性睡眠呼吸暂停（OSA）具有共同的病理生理机制，可能存在内在关联，但它们的患病率、临床特征和多导睡眠图（PSG）模式仍未被充分理解。
描述大量难治性高血压（RHT）患者中 OSA 的患病率和 PSG 模式。
这是一项涉及 418 例 RHT 患者（30.9%为男性；平均年龄 62.5±9.9 岁）的横断面研究，这些患者接受了整夜 PSG 检查。RfHT 定义为使用五种或更多种降压药物（包括螺内酯）控制不住的动态血压监测。使用单变量分析比较 RHT 和 RfHT，使用多变量分析评估 OSA 的独立相关因素。
共有 90 例患者（21.5%）被诊断为 RfHT（26.7%为男性；平均年龄 58.5±8.3 岁）。与难治性患者相比，RfHT 患者年龄更小，吸烟和既往心血管疾病患病率更高，尤其是卒中。两组患者的体重指数无差异。两组患者的 OSA 患病率（80.0% vs. 82.9%）和中重度 OSA（51.1% vs. 57.0%）以及呼吸暂停低通气指数相似。相反，难治性高血压患者的睡眠效率更好（78% vs. 71%），总睡眠时间更长（315 分钟 vs. 281 分钟），睡眠潜伏期更短（11 分钟 vs. 17 分钟）。两组患者的快速眼动睡眠、氧饱和度、微觉醒指数和周期性肢体运动均无差异。
在这项大型 RHT 队列研究中，难治性和难治性高血压患者的 OSA 患病率相似，尽管根据定义使用螺内酯的难治性高血压患者年龄更小，睡眠模式似乎更好。
