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SLEEP AND BREATHING: K. Mae Hla, James B. Skatrud, Laurel Finn, Mari Palta, and Terry Young The Effect of Correction of Sleep-Disordered Breathing on BP in Untreated Hypertension Chest 2002; 122: 1125-1132 [Abstract] [Full text] [PDF]

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Mechanisms for development of hypertension in OSA

Abhimanyu Lal, Vandna Sharma   (7 November 2002)

Mechanisms for development of hypertension in OSA 7 November 2002
Abhimanyu Lal, Doctor , Vandna Sharma Send letter to journal: Re: Mechanisms for development of hypertension in OSA drabhilal{at}yahoo.co.uk Abhimanyu Lal, et al.	Dear Sirs, The article by Mae Hla et al entitled “The Effect of Correction of Sleep-Disordered Breathing on BP in Untreated Hypertension” suggests a causal relationship between Obstructive Sleep Apnoea and increased nocturnal BP in hypertensives. [1] Sjostrom et al, in their article “Prevalence of sleep apnoea and snoring in hypertensive men: a population based study” have shown that sleep disordered breathing is more common in patients with hypertension, and that desaturation index (DI) >= 10 and lowest desaturation are independent predictors of hypertension irrespective of confounders. [2] The study by Hu et al “The influence of nasal continual positive airway pressure on some vasoactive substances in patients with obstructive sleep apnoea syndrome” has demonstrated an increased level of vasoactive substances (Thromboxane B2, Angiotensin II, Endothelenin I, Renin and cyclic AMP) in patients with OSA. A significant reduction in the levels of these substances was seen following treatment with nasal CPAP. [3] Further, Elmasry et al have demonstrated that in a population of hypertensive males, obstructive sleep apnoea is associated with increased urinary concentrations of catecholamines independent of major confounding factors, suggesting increased sympathoadrenal activity. [4] There is also evidence that obstructive sleep apnoea is independently associated with insulin resistance, which is a significant factor in the development of hypertension, as demonstrated in the study by Ip et al. [5] There is strong evidence that obstructive sleep apnoea contributes to development of hypertension. Further study is required to determine the exact mechanism of development of hypertension in OSA patients. References: 1. K. Mae Hla, MD, MHS; James B. Skatrud, MD; Laurel Finn, MS; Mari Palta, PhD and Terry Young, PhD. The Effect of Correction of Sleep- Disordered Breathing on BP in Untreated Hypertension. (Chest. 2002;122:1125-1132.) © 2002. 2. Sjostrom C, Lindberg E, Elmasry A, Hagg A, Svardsudd K, Janson C. Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. Thorax 2002 Jul;57(7):602-7. 3. Hu X, Kang J, Xiao D, Wang W, Hou X, Yu R. [The influence of nasal continual positive airway pressure on some vasoactive substances in patients with obstructive sleep apnoea syndrome. : Zhonghua Jie He He Hu Xi Za Zhi 2002 Jan;25(1):36-8. 4. Elmasry A, Lindberg E, Hedner J, Janson C, Boman G. Obstructive sleep apnoea and urine catecholamines in hypertensive males: a population- based study. Eur Respir J 2002 Mar;19(3):511-7. 5. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnoea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002 Mar 1;165(5):670-6.