Skip to main content
SpringerLink
Log in

Short-term blood pressure variability in hypertensive patients with obstructive sleep apnea syndrome

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

Short-term blood pressure (BP) variability is an important cardiovascular risk factor. Whether patients with obstructive sleep apnea syndrome (OSAS) indeed display increased short-term BP variability and, if so, what is its underlying mechanism remain unclear. We compared the short-term BP variability between hypertensive patients with OSAS (OSAS group; n= 212) and those without OSAS (control group; n = 82) by examining data of 24-h ambulatory BP monitoring (ABPM) and investigated the effects of continuous positive airway pressure (CPAP) therapy on short-term BP variability in 37 hypertensive patients with OSAS. Short-term BP variability was calculated with the average real variability (ARV) of awake and sleep BP. ARVs of sleep systolic BP (SBP) and diastolic BP (DBP) were significantly higher in the OSAS group than in the control group. There was no significant difference in ARVs of awake SBP and DBP between the two groups. In the OSAS group, multiple regression analyses revealed that the body mass index (BMI) was an independent determinant for ARV of sleep DBP and that the lowest SpO2 was an independent determinant for ARVs of sleep SBP and sleep DBP. CPAP therapy decreased ARVs of sleep SBP and DBP. These results suggested that higher short-term BP variability during sleep is a characteristic feature of hypertensive patients with OSAS and that obesity and hypoxemia play essential roles in increasing short-term BP variability during sleep. CPAP therapy may improve exaggerated short-term BP variability during sleep in patients with OSAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mancia G, Parati G, Hennig M et al. ELSA Investigators. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J. Hypertens. 2001; 19: 1981–9.

    Article  CAS  PubMed  Google Scholar 

  2. Diaz KM, Veerabhadrappa P, Kashem MA et al. Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African Americans. Hypertens. Res. 2012; 35: 55–61.

    Article  CAS  PubMed  Google Scholar 

  3. Schillaci G, Bilo G, Pucci G et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension 2012; 60: 369–77.

    Article  CAS  PubMed  Google Scholar 

  4. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.

    Article  PubMed  Google Scholar 

  5. Björklund K, Lind L, Zethelius B, Berglund L, Lithell H. Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men. J. Hypertens. 2004; 22: 1691–7.

    Article  PubMed  Google Scholar 

  6. Kikuya M, Ohkubo T, Asayama K et al. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 2005; 45: 240–5.

    Article  CAS  PubMed  Google Scholar 

  7. Eto M, Toba K, Akishita M et al. Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension. Hypertens. Res. 2005; 28: 1–7.

    Article  PubMed  Google Scholar 

  8. Mancia G, Bombelli M, Facchetti R et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007; 49: 1265–70.

    Article  CAS  PubMed  Google Scholar 

  9. Pierdomenico SD, Di Nicola M, Esposito AL et al. Prognostic value of different indices of blood pressure variability in hypertensive patients. Am. J. Hypertens. 2009; 22: 842–7.

    Article  PubMed  Google Scholar 

  10. Pringle E, Phillips C, Thijs L et al., Syst-Eur investigators. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J. Hypertens. 2003; 21: 2251–7.

    Article  CAS  PubMed  Google Scholar 

  11. Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am. J. Hypertens. 2007; 20: 154–61.

    Article  PubMed  Google Scholar 

  12. Eguchi K, Ishikawa J, Hoshide S et al. Night time blood pressure variability is a strong predictor for cardiovascular events in patients with type 2 diabetes. Am. J. Hypertens. 2009; 22: 46–51.

    Article  PubMed  Google Scholar 

  13. Ozawa M, Tamura K, Okano Y et al. Identification of an increased short-term blood pressure variability on ambulatory blood pressure monitoring as a coronary risk factor in diabetic hypertensives. Clin. Exp. Hypertens. 2009; 31: 259–70.

    Article  PubMed  Google Scholar 

  14. Kario K. Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure. Hypertens. Res. 2009; 32: 428–32.

    Article  PubMed  Google Scholar 

  15. Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation 1998; 98: 1071–77.

    Article  CAS  PubMed  Google Scholar 

  16. Steinhorst AP, Goncalves SC, Oliveira AT et al. Influence of sleep apnea severity on blood pressure variability of patients with hypertension. Sleep Breath. 2014; 18: 397–401.

    Article  PubMed  Google Scholar 

  17. Bao X, Nelesen RA, Loredo JS, Dimsdale JE, Ziegler MG. Blood pressure variability in obstructive sleep apnea: role of sympathetic nervous activity and effect of continuous positive airway pressure. Blood Press. Monit. 2002; 7: 301–7.

    Article  PubMed  Google Scholar 

  18. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046–53.

    Article  PubMed  Google Scholar 

  19. Martínez-García MA, Campos-Rodríguez F, Catalán-Serra P et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am. J. Respir. Crit. Care Med. 2012; 186: 909–16.

    Article  PubMed  Google Scholar 

  20. Becker HF, Jerrentrup A, Ploch T et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107: 68–73.

    Article  PubMed  Google Scholar 

  21. Barbé F, Mayoralas LR, Duran J et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann. Intern. Med. 2001; 134: 1015–23.

    Article  PubMed  Google Scholar 

  22. Kasiakogias A, Tsioufis C, Thomopoulos C et al. Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea: a 3-year follow-up. J. Hypertens. 2013; 31: 352–60.

    Article  CAS  PubMed  Google Scholar 

  23. Sasaki N, Ozono R, Yamauchi R et al. The relationship between morning hypertension and sleep quality in patients with obstructive sleep apnea syndrome. Clin. Exp. Hypertens. 2013; 35: 250–6.

    Article  PubMed  Google Scholar 

  24. Rechtschaffen A, Kales A. A Manual of Standardized Terminology Techniques and Scoring System for Sleep States of Human Subjects. Publication no. 204. National Institutes of Health: Washington, DC, 1968.

    Google Scholar 

  25. ASDA. EEG arousals: scoring rules and examples. Sleep 1992; 15: 173–84.

    Google Scholar 

  26. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22: 667–89.

    Google Scholar 

  27. Nakamura K, Kikuya M, Hara A et al. Validation of the FM-800 ambulatory blood pressure monitor according to the Association for the Advancement of Medical Instrumentation criteria and the International Protocol. Clin. Exp. Hypertens. 2010; 32: 523–7.

    Article  PubMed  Google Scholar 

  28. Kario K, Pickering TG, Umeda Y et al. Morning surge in blood pressure as a predictor of silent and clinical cer-ebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003; 107: 1401–6.

    Article  PubMed  Google Scholar 

  29. Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J. Hypertens. 2005; 23: 505–11.

    Article  CAS  PubMed  Google Scholar 

  30. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd edn. American Academy of Sleep Medicine: Westchester, IL, 2014; 292–9.

    Google Scholar 

  31. Stolarz-Skrzypek K, Thijs L, Richart T et al. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertens. Res. 2010; 33: 757–66.

    Article  PubMed  Google Scholar 

  32. Sasaki N, Ozono R, Yamauchi R et al. Age-related differences in the mechanism of non-dipping among patients with obstructive sleep apnea syndrome. Clin. Exp. Hypertens. 2012; 34: 270–7.

    Article  PubMed  Google Scholar 

  33. Hall JE, da Silva AA, do Carmo JM et al. Obesity-induced hypertension: role of sympathetic nervous system, leptin, and melanocortins. J. Biol. Chem. 2010; 285: 17271–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Pennestri MH, Montplaisir J, Colombo R, Lavigne G, Lanfranchi PA. Nocturnal blood pressure changes in patients with restless legs syndrome. Neurology 2007; 68: 1213–18.

    Article  CAS  PubMed  Google Scholar 

  35. Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N. Engl. J. Med. 1993; 328: 303–7.

    Article  CAS  PubMed  Google Scholar 

  36. Narkiewicz K, Somers VK. The sympathetic nervous system and obstructive sleep apnea: implications for hypertension. J. Hypertens. 1997; 15: 1613–19.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, 3-8-6, Senda-machi, Naka-ku, Hiroshima, 730-0052, Japan

    Nobuo Sasaki & Saeko Fujiwara

  2. Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

    Ryoji Ozono

  3. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

    Tomohiko Kisaka & Yasuki Kihara

  4. Department of Clinical Laboratories, Mitsubishi Mihara Hospital, Mihara, Japan

    Yoshinobu Edahiro & Tomomi Okita

  5. Internal Medicine, Mitsubishi Mihara Hospital, Mihara, Japan

    Kazushi Teramen

Authors
  1. Nobuo Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryoji Ozono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshinobu Edahiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomomi Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazushi Teramen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomohiko Kisaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Saeko Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuki Kihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuo Sasaki.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sasaki, N., Ozono, R., Edahiro, Y. et al. Short-term blood pressure variability in hypertensive patients with obstructive sleep apnea syndrome. Sleep Biol. Rhythms 13, 117–126 (2015). https://doi.org/10.1111/sbr.12094

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1111/sbr.12094

Key words

Search

Navigation