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Relationship of Systolic BP to Obstructive Sleep Apnea in Patients With Heart Failure^*

^* From the From the Sleep Research Laboratory (Dr. Sin), Toronto Rehabilitation Institute; Department of Medicine (Ms. Fitzgerald and Dr. Bradley), Toronto General Hospital/University Health Network; and Department of Medicine (Drs. Parker, Newton, Logan, and Floras), Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

Correspondence to: T. Douglas Bradley, MD, NU 9–112, The Toronto General Hospital/University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada; e-mail: douglas.bradley{at}utoronto.ca

Study objectives: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension in the general population. Hypertension is, in turn, an important risk factor for the development and progression of congestive heart failure (CHF). Our objective was to determine whether OSA would be associated with elevated daytime BP in medically treated patients with CHF.

Design: Cross-sectional study.

Setting: Tertiary care, university-affiliated sleep disorders and heart failure clinics.

Patients: Three hundred one consecutive patients with CHF.

Measurements and results: We measured daytime BP and performed overnight sleep studies to assess for the presence of OSA. Among these patients, OSA was present in 121 patients (40%) and their systolic BP was significantly higher than in patients without OSA. Patients with OSA were 2.89 times (95% confidence interval, 1.25 to 6.73) more likely to have systolic hypertension (ie, BP 140 mm Hg) than those without OSA after controlling for other risk factors, including obesity. The degree of systolic BP elevation was directly related to the frequency of obstructive apneas and hypopneas.

Conclusions: In medically treated patients with CHF, daytime systolic BP and the prevalence of systolic hypertension are significantly increased in patients with OSA, compared to those without OSA, independent of other potentially confounding factors. OSA may therefore have contributed to the presence of systolic hypertension in some of these patients.

Key Words: epidemiology • heart failure • hypertension • sleep apnea

This article has been cited by other articles:

				K. Usui, T. D. Bradley, J. Spaak, C. M. Ryan, T. Kubo, Y. Kaneko, and J. S. Floras Inhibition of Awake Sympathetic Nerve Activity of Heart Failure Patients With Obstructive Sleep Apnea by Nocturnal Continuous Positive Airway Pressure J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2008 - 2011. [Abstract] [Full Text] [PDF]

				A. Tulaimat, B. Mokhlesi, D. Stevens, M. D. Weinstein, T. D. Bradley, J. S. Floras, and K. Usui Continuous Positive Airway Pressure in Patients with Heart Failure N. Engl. J. Med., July 3, 2003; 349(1): 93 - 95. [Full Text] [PDF]