Advertisement

Sleep and Breathing

, Volume 19, Issue 4, pp 1199–1203 | Cite as

White coat hypertension and obstructive sleep apnea

  • Li LiEmail author
  • Li-zhu Guo
  • Jie Li
  • Ying Wang
  • Xin Liu
  • Ya-hui Lv
  • Chang-sheng Ma
Original Article

Abstract

Purpose

This study aimed to determine blood pressure characteristics and long-term progress in patients with white coat hypertension (WCH) and obstructive sleep apnea (OSA).

Methods

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) and sleep test results over a period of 26 months were analyzed from WCH patients with OSA (n = 28), WCH patients (n = 23), and healthy control subjects (n = 27).

Results

At the end of observation, WCH patients with OSA presented significantly increased daytime and nighttime BP and lower diurnal difference of SBP (all Ps < 0.05) and the increased rate of “non-dipper” status (SBP 28.6 %, DBP 32.1 %) was significantly higher when compared with WCH and control groups (all Ps < 0.01). Sustained hypertension was observed in 42.8 % of the WCH patients with OSA, which was significantly higher than that in the WCH and control groups (Ps < 0.01) and was predicted by non-dipper status via 24-h ambulatory SBP/DBP monitoring (Ps < 0.05).

Conclusion

WCH may represent a prehypertension status, which could develop into sustained hypertension with OSA.

Keywords

Blood pressure Non-dipper Obstructive sleep apnea White coat hypertension 

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Pickering TG, Coats A, Mallion JM, Mancia G, Verdecchia P (1999) Blood pressure monitoring. Task Force V: white-coat hypertension. Blood Press Monit 4:333–341CrossRefPubMedGoogle Scholar
  2. 2.
    Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F (2008) Short and long-term risk of cardiovascular events in white-coat hypertension. J Hum Hypertens 22:408–414CrossRefPubMedGoogle Scholar
  3. 3.
    Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Sacchi N, Guerrieri M, Comparato E, Porcellati C (1996) Identification of subjects with white-coat hypertension and persistently normal ambulatory blood pressure. Blood Press Monit 1:217–222PubMedGoogle Scholar
  4. 4.
    Mancia G, Bombelli M, Seravalle G, Grassi G (2011) Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 8:686–693CrossRefPubMedGoogle Scholar
  5. 5.
    Verdecchia P, Angeli F (2005) The natural history of white-coat hypertension in the long term. Blood Press Monit 10:65–66CrossRefPubMedGoogle Scholar
  6. 6.
    Silverberg DS, Oksenberg A (2001) Are sleep-related breathing disorders important contributing factors to the production of essential hypertension? Curr Hypertens Rep 3:209–215CrossRefPubMedGoogle Scholar
  7. 7.
    Informe V (1993) The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC-V). Arch Intern Med 153:154–183CrossRefGoogle Scholar
  8. 8.
    Pickering T, Kaplan N, Krakoff L (1996) American Society of Hypertension Expert Panel: conclusions and recommendations on the clinical use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 9:1–11CrossRefPubMedGoogle Scholar
  9. 9.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. National Institutes of Health, Washington, DCGoogle Scholar
  10. 10.
    Quan SF, Gillin JC, Littner MR, Shepard JW (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:662–689PubMedGoogle Scholar
  11. 11.
    Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM, Eguchi K, Burg M, Gerin W (2008) The misdiagnosis of hypertension: the role of patient anxiety. Arch Intern Med 168:2459CrossRefPubMedGoogle Scholar
  12. 12.
    Tsai PS (2002) White coat hypertension: understanding the concept and examining the significance. J Clin Nurs 11:715–722CrossRefPubMedGoogle Scholar
  13. 13.
    Mancia G, Zanchetti A (1996) White-coat hypertension: misnomers, misconceptions and misunderstandings. What should we do next? J. Hypertens 14:1049–1052CrossRefGoogle Scholar
  14. 14.
    Mancia G (2000) White coat effect. Innocuous or adverse phenomenon? Eur. Heart J 21:1647–1648CrossRefGoogle Scholar
  15. 15.
    Gustavsen PH, Høegholm A, Bang LE, Kristensen KS (2003) White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 17:811–817CrossRefPubMedGoogle Scholar
  16. 16.
    Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R (2006) Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 47:846–853CrossRefPubMedGoogle Scholar
  17. 17.
    Ugajin T, Hozawa A, Ohkubo T, Asayama K, Kikuya M, Obara T, Metoki H, Hoshi H, Hashimoto J, Totsune K, Satoh H, Tsuji I, Imai Y (2005) White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study. Arch Intern Med 165:1541–1546CrossRefPubMedGoogle Scholar
  18. 18.
    García-Río F, Pino JM, Alonso A, Arias MA, Martínez I, Alvaro D, Villamor J (2004) White coat hypertension in patients with obstructive sleep apnea-hypopnea syndrome. Chest 125:817–822CrossRefPubMedGoogle Scholar
  19. 19.
    Sulit L, Storfer-Isser A, Kirchner HL, Redline S (2006) Differences in polysomnography predictors for hypertension and impaired glucose tolerance. Sleep 29:777–783PubMedGoogle Scholar
  20. 20.
    Rajagopalan N (2011) Obstructive sleep apnea: not just a sleep disorder. J Postgrad Med 57:168–175CrossRefPubMedGoogle Scholar
  21. 21.
    Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M (2008) Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep 31:795–800PubMedCentralPubMedGoogle Scholar
  22. 22.
    Pankow W, Nabe B, Lies A, Becker H, Köhler U, Kohl FV, Lohmann FW (1997) Influence of sleep apnea on 24-hour blood pressure. Chest Journal 112:1253–1258CrossRefGoogle Scholar
  23. 23.
    Loredo JS, Ancoli-Israel S, Joel E, Dimsdale (2001) Sleep quality and blood pressure dipping in obstructive sleep apnea. Am J Hypertens 14:887–892CrossRefPubMedGoogle Scholar
  24. 24.
    Ancoli-Israel S, Stepnowsky C, Dimsdale J, Marler M, Cohen-Zion M, Johnson S (2002) The effect of race and sleep-disordered breathing on nocturnal BP “dipping” analysis in an older population. Chest Journal 122:1148–1155CrossRefGoogle Scholar
  25. 25.
    Baguet JP, Barone-Rochette G, Pépin JL (2009) Hypertension and obstructive sleep apnoea syndrome: current perspectives. J Hum Hypertens 23:431–443CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Li Li
    • 1
    Email author
  • Li-zhu Guo
    • 1
  • Jie Li
    • 1
  • Ying Wang
    • 1
  • Xin Liu
    • 1
  • Ya-hui Lv
    • 1
  • Chang-sheng Ma
    • 1
    • 2
  1. 1.Cardiovascular Center, Beijing Tong Ren HospitalCapital University of Medical SciencesBeijingChina
  2. 2.Atrial Fibrillation Center, Cardiology Department, Beijing An Zhen HospitalCapital University of Medical SciencesBeijingChina

Personalised recommendations