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doi:10.1378/chest.06-2703
(Chest. 2007; 131:1379-1386)
© 2007 American College of Chest Physicians
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Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling*

Luciano F. Drager, MD; Luiz A. Bortolotto, MD, PhD; Adelaide C. Figueiredo, BSc; Bruno Caldin Silva, MS; Eduardo M. Krieger, MD, PhD and Geraldo Lorenzi-Filho, MD, PhD

* From the Hypertension Unit (Drs. Drager, Bortolotto, and Krieger, and Mr. Silva) and Sleep Laboratory, Pulmonary Division (Ms. Figueiredo and Dr. Lorenzi-Filho), Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to: Geraldo Lorenzi-Filho, PhD, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, CEP 05403–904, São Paulo, Brazil; e-mail: geraldo.lorenzi{at}incor.usp.br

Abstract

Study objectives: Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure.

Design: We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index.

Measurements and results: Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001).

Conclusions: Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.

Key Words: arterial stiffness • heart disease • hypertension • obstructive sleep apnea






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