Analysis of Trends of Sleep-Related Breathing Disorders in Patients with Systemic Essential Hypertension
Author(s)
Santosh Kumar Sinha1,
Anand Kumar2,
Avinash Jain2,
Ramesh Thakur1,
Chandra Mohan Varma1,
Vinay Krishna1,
Avdhesh Kumar2,
Nirlep Gajiwala3,
Ashok Thakkar3
Affiliation(s)
1 L.P.S. Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. 2 M.L. Chest Hospital, G.S.V.M. Medical College, Kanpur, India. 3 Sahajanand Medical Technologies Pvt. Ltd., Surat, India.
1 L.P.S. Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. 2 M.L. Chest Hospital, G.S.V.M. Medical College, Kanpur, India. 3 Sahajanand Medical Technologies Pvt. Ltd., Surat, India.
ABSTRACT
Background: Studies have revealed a strong link between sleep-related breathing disorders and essential hypertension. However, the trends of sleep-disordered breathing in hypertensive patients have not been analyzed frequently. Methods: In this prospective, single-center and observational study, random patients with systemic essential hypertension, who were visiting GSVM Medical College, Kanpur, India between December 2012 and July 2014, were selected. After obtaining informed consent, patients were analyzed for symptoms of sleep-disordered breathing and Epworth Sleepiness Scale. Subsequently, all patients underwent overnight polysomnography to estimate the events of apnea and hypopnea. Observed data were compared between stage I and stage II hypertensive patients. Results: A total of 51 patients (age: 45.7 ± 13.43 years), comprising 36 stage I hypertensives and 15 stage II hypertensives, were enrolled in the study. About 47% of these patients displayed no symptoms of sleep-disordered breathing. Compared to stage I hypertensives, higher percentage of stage II hypertensives reported excessive day time sleepiness. Sleep latency time and sleep architecture were comparable between stage I and stage II hypertensives. Stage II hypertensives displayed shorter total sleep time and higher snore time than stage I hyper-tensives. Apnea Hypopnea Index (AHI) values increased with the severity of hypertension. Nocturnal oxygen desaturation was present in 25.0% and 53.3% of stage I and II hypertensives respectively. Mean lowest oxygen saturation was lower and the mean C-reactive protein levels were higher in stage II hypertensives as compared to stage I hypertensives. The mean C-reactive protein levels increased with increasing AHI scores, while the mean lowest oxygen saturation decreased with increasing AHI scores. Conclusion: Almost half of the hypertensives patients reported no symptoms of sleep-disordered breathing. Sleep-disordered breathing was more common and was more severe in majority of patients with stage II hypertension as compared to that in patients with stage I hypertension.
Background: Studies have revealed a strong link between sleep-related breathing disorders and essential hypertension. However, the trends of sleep-disordered breathing in hypertensive patients have not been analyzed frequently. Methods: In this prospective, single-center and observational study, random patients with systemic essential hypertension, who were visiting GSVM Medical College, Kanpur, India between December 2012 and July 2014, were selected. After obtaining informed consent, patients were analyzed for symptoms of sleep-disordered breathing and Epworth Sleepiness Scale. Subsequently, all patients underwent overnight polysomnography to estimate the events of apnea and hypopnea. Observed data were compared between stage I and stage II hypertensive patients. Results: A total of 51 patients (age: 45.7 ± 13.43 years), comprising 36 stage I hypertensives and 15 stage II hypertensives, were enrolled in the study. About 47% of these patients displayed no symptoms of sleep-disordered breathing. Compared to stage I hypertensives, higher percentage of stage II hypertensives reported excessive day time sleepiness. Sleep latency time and sleep architecture were comparable between stage I and stage II hypertensives. Stage II hypertensives displayed shorter total sleep time and higher snore time than stage I hyper-tensives. Apnea Hypopnea Index (AHI) values increased with the severity of hypertension. Nocturnal oxygen desaturation was present in 25.0% and 53.3% of stage I and II hypertensives respectively. Mean lowest oxygen saturation was lower and the mean C-reactive protein levels were higher in stage II hypertensives as compared to stage I hypertensives. The mean C-reactive protein levels increased with increasing AHI scores, while the mean lowest oxygen saturation decreased with increasing AHI scores. Conclusion: Almost half of the hypertensives patients reported no symptoms of sleep-disordered breathing. Sleep-disordered breathing was more common and was more severe in majority of patients with stage II hypertension as compared to that in patients with stage I hypertension.
Cite this paper
Sinha, S. , Kumar, A. , Jain, A. , Thakur, R. , Varma, C. , Krishna, V. , Kumar, A. , Gajiwala, N. and Thakkar, A. (2015) Analysis of Trends of Sleep-Related Breathing Disorders in Patients with Systemic Essential Hypertension. International Journal of Clinical Medicine, 6, 561-569. doi: 10.4236/ijcm.2015.68075.
Sinha, S. , Kumar, A. , Jain, A. , Thakur, R. , Varma, C. , Krishna, V. , Kumar, A. , Gajiwala, N. and Thakkar, A. (2015) Analysis of Trends of Sleep-Related Breathing Disorders in Patients with Systemic Essential Hypertension. International Journal of Clinical Medicine, 6, 561-569. doi: 10.4236/ijcm.2015.68075.
References
[1] Peppard, P.E., Young, T., Palta, M. and Skatrud, J. (2000) Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension. The New England Journal of Medicine, 342, 1378-1384.
http://dx.doi.org/10.1056/NEJM200005113421901 [2] Gangwisch, J.E., Heymsfield, S.B., Boden-Albala, B., Buijs, R.M., Kreier, F., Pickering, T.G., et al. (2006) Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey. Hypertension, 47, 833-839.
http://dx.doi.org/10.1161/01.hyp.0000217362.34748.e0 [3] Haas, D.C., Foster, G.L., Nieto, F.J., Redline, S., Resnick, H.E., Robbins. J.A., et al. (2005) Age-Dependent Associations between Sleep-Disordered Breathing and Hypertension: Importance of Discriminating between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study. Circulation, 111, 614-621.
http://dx.doi.org/10.1161/01.CIR.0000154540.62381.CF [4] Silverberg, D.S. and Oksenberg, A. (2001) Are Sleep-Related Breathing Disorders Important Contributing Factors to the Production of Essential Hypertension? Current Hypertension Reports, 3, 209-215.
http://dx.doi.org/10.1007/s11906-001-0040-8 [5] Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L., et al. (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. The Journal of the American Medical Association, 289, 2560-2572.
http://dx.doi.org/10.1001/jama.289.19.2560 [6] Kales, A. and Rechtschaffen, A., University of California, Los Angeles, Brain Information Service & NINDB Neurological Information Network (U.S.) (1968) A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. In: Rechtscaffen, A. and Kales, A., Eds., Neurological Information Network, National Institute of Neurological Diseases and Blindness, Bethesda. [7] Berry, R.B., Budhiraja, R., Gottlieb, D.J., Gozal, D., Iber, C., Kapur, V.K., et al. (2012) Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 8, 597-619. [8] Kapur, V.K., Resnick, H.E., and Gottlieb, D.J., Sleep Heart Health Study Group (2008) Sleep Disordered Breathing and Hypertension: Does Self-Reported Sleepiness Modify the Association? Sleep, 31, 1127-1132. [9] Grote, L., Ploch, T., Heitmann, J., Knaack, L., Penzel, T. and Peter, J.H. (1999) Sleep-Related Breathing Disorder Is an Independent Risk Factor for Systemic Hypertension. American Journal of Respiratory and Critical Care Medicine, 160, 1875-1882.
http://dx.doi.org/10.1164/ajrccm.160.6.9811054 [10] Nieto, F.J., Young, T.B., Lind, B.K., Shahar, E., Samet, J.M., Redline, S., et al. (2000) Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study. Sleep Heart Health Study. The Journal of the American Medical Association, 283, 1829-1836.
http://dx.doi.org/10.1001/jama.283.14.1829 [11] Lavie, P., Herer, P. and Hoffstein, V. (2000) Obstructive Sleep Apnoea Syndrome as a Risk Factor for Hypertension: Population Study. BMJ, 320, 479-482.
http://dx.doi.org/10.1136/bmj.320.7233.479 [12] Bixler, E.O., Vgontzas, A.N., Lin, H.M., Ten Have, T., Leiby, B.E., Vela-Bueno, A., et al. (2000) Association of Hypertension and Sleep-Disordered Breathing. Archives of Internal Medicine, 160, 2289-2295.
http://dx.doi.org/10.1001/archinte.160.15.2289 [13] Quan, S.F. and Gersh, B.J., National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute (2004) Cardiovascular Consequences of Sleep-Disordered Breathing: Past, Present and Future. Report of a Workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation, 109, 951-957.
http://dx.doi.org/10.1161/01.CIR.0000118216.84358.22 [14] Cintra, F.D., Tufik, S., Paola, Ad., Feres, M.C., Melo-Fujita, L., Oliveira, W., et al. (2011) Cardiovascular Profile in Patients with Obstructive Sleep Apnea. Arquivos Brasileiros de Cardiologia, 96, 293-299.
http://dx.doi.org/10.1590/S0066-782X2011005000030 [15] Kumar, R. and Kochhar, S. (2013) C-Reactive Protein and Severity of Hypertension. Journal of Advance Researches in Biological Sciences, 5, 331-335. [16] Katz, I., Stradling, J., Slutsky, A.S., Zamel, N. and Hoffstein, V. (1990) Do Patients with Obstructive Sleep Apnea Have Thick Necks? American Review of Respiratory Disease, 141, 1228-1231.
http://dx.doi.org/10.1164/ajrccm/141.5_Pt_1.1228 [17] Grote, L., Hedner, J. and Peter, J.H. (2001) Mean Blood Pressure, Pulse Pressure and Grade of Hypertension in Untreated Hypertensive Patients with Sleep-Related Breathing Disorder. Journal of Hypertension, 19, 683-690.
http://dx.doi.org/10.1097/00004872-200104000-00004 [18] Sjöström, C., Lindberg, E., Elmasry, A., Hägg, A., Svärdsudd, K. and Janson, C. (2002) Prevalence of Sleep Apnoea and Snoring in Hypertensive Men: A Population Based Study. Thorax, 57, 602-607.
http://dx.doi.org/10.1136/thorax.57.7.602
[1] Peppard, P.E., Young, T., Palta, M. and Skatrud, J. (2000) Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension. The New England Journal of Medicine, 342, 1378-1384.
http://dx.doi.org/10.1056/NEJM200005113421901 [2] Gangwisch, J.E., Heymsfield, S.B., Boden-Albala, B., Buijs, R.M., Kreier, F., Pickering, T.G., et al. (2006) Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey. Hypertension, 47, 833-839.
http://dx.doi.org/10.1161/01.hyp.0000217362.34748.e0 [3] Haas, D.C., Foster, G.L., Nieto, F.J., Redline, S., Resnick, H.E., Robbins. J.A., et al. (2005) Age-Dependent Associations between Sleep-Disordered Breathing and Hypertension: Importance of Discriminating between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study. Circulation, 111, 614-621.
http://dx.doi.org/10.1161/01.CIR.0000154540.62381.CF [4] Silverberg, D.S. and Oksenberg, A. (2001) Are Sleep-Related Breathing Disorders Important Contributing Factors to the Production of Essential Hypertension? Current Hypertension Reports, 3, 209-215.
http://dx.doi.org/10.1007/s11906-001-0040-8 [5] Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L., et al. (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. The Journal of the American Medical Association, 289, 2560-2572.
http://dx.doi.org/10.1001/jama.289.19.2560 [6] Kales, A. and Rechtschaffen, A., University of California, Los Angeles, Brain Information Service & NINDB Neurological Information Network (U.S.) (1968) A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. In: Rechtscaffen, A. and Kales, A., Eds., Neurological Information Network, National Institute of Neurological Diseases and Blindness, Bethesda. [7] Berry, R.B., Budhiraja, R., Gottlieb, D.J., Gozal, D., Iber, C., Kapur, V.K., et al. (2012) Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 8, 597-619. [8] Kapur, V.K., Resnick, H.E., and Gottlieb, D.J., Sleep Heart Health Study Group (2008) Sleep Disordered Breathing and Hypertension: Does Self-Reported Sleepiness Modify the Association? Sleep, 31, 1127-1132. [9] Grote, L., Ploch, T., Heitmann, J., Knaack, L., Penzel, T. and Peter, J.H. (1999) Sleep-Related Breathing Disorder Is an Independent Risk Factor for Systemic Hypertension. American Journal of Respiratory and Critical Care Medicine, 160, 1875-1882.
http://dx.doi.org/10.1164/ajrccm.160.6.9811054 [10] Nieto, F.J., Young, T.B., Lind, B.K., Shahar, E., Samet, J.M., Redline, S., et al. (2000) Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study. Sleep Heart Health Study. The Journal of the American Medical Association, 283, 1829-1836.
http://dx.doi.org/10.1001/jama.283.14.1829 [11] Lavie, P., Herer, P. and Hoffstein, V. (2000) Obstructive Sleep Apnoea Syndrome as a Risk Factor for Hypertension: Population Study. BMJ, 320, 479-482.
http://dx.doi.org/10.1136/bmj.320.7233.479 [12] Bixler, E.O., Vgontzas, A.N., Lin, H.M., Ten Have, T., Leiby, B.E., Vela-Bueno, A., et al. (2000) Association of Hypertension and Sleep-Disordered Breathing. Archives of Internal Medicine, 160, 2289-2295.
http://dx.doi.org/10.1001/archinte.160.15.2289 [13] Quan, S.F. and Gersh, B.J., National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute (2004) Cardiovascular Consequences of Sleep-Disordered Breathing: Past, Present and Future. Report of a Workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation, 109, 951-957.
http://dx.doi.org/10.1161/01.CIR.0000118216.84358.22 [14] Cintra, F.D., Tufik, S., Paola, Ad., Feres, M.C., Melo-Fujita, L., Oliveira, W., et al. (2011) Cardiovascular Profile in Patients with Obstructive Sleep Apnea. Arquivos Brasileiros de Cardiologia, 96, 293-299.
http://dx.doi.org/10.1590/S0066-782X2011005000030 [15] Kumar, R. and Kochhar, S. (2013) C-Reactive Protein and Severity of Hypertension. Journal of Advance Researches in Biological Sciences, 5, 331-335. [16] Katz, I., Stradling, J., Slutsky, A.S., Zamel, N. and Hoffstein, V. (1990) Do Patients with Obstructive Sleep Apnea Have Thick Necks? American Review of Respiratory Disease, 141, 1228-1231.
http://dx.doi.org/10.1164/ajrccm/141.5_Pt_1.1228 [17] Grote, L., Hedner, J. and Peter, J.H. (2001) Mean Blood Pressure, Pulse Pressure and Grade of Hypertension in Untreated Hypertensive Patients with Sleep-Related Breathing Disorder. Journal of Hypertension, 19, 683-690.
http://dx.doi.org/10.1097/00004872-200104000-00004 [18] Sjöström, C., Lindberg, E., Elmasry, A., Hägg, A., Svärdsudd, K. and Janson, C. (2002) Prevalence of Sleep Apnoea and Snoring in Hypertensive Men: A Population Based Study. Thorax, 57, 602-607.
http://dx.doi.org/10.1136/thorax.57.7.602