期刊
JOURNAL OF HYPERTENSION
卷 40, 期 7, 页码 1327-1335出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HJH.0000000000003144
关键词
clinical profile; cohort; obstructive sleep apnea; prevalence; refractory hypertension
资金
- Conselho Brasileiro de Desenvolvimento Cientifico e Tecnologico (CNPq, Distrito Federal, Brazil)
- Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ, Brazil)
This study describes the prevalence of obstructive sleep apnea (OSA) and polysomnography (PSG) pattern in patients with refractory hypertension (RfHT). Patients with RfHT have similar OSA prevalence compared to patients with resistant hypertension, but they are younger and have a better sleep pattern.
Background: 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. Objective: To describe OSA prevalence and PSG pattern of patients with RfHT in a large cohort of resistant hypertension (RHT). Methods: 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. Results: 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. Conclusion: 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.
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