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Diabetes and Hypertension pp 51–63Cite as

Diabetes and Hypertension in People with Sleep Apnea: Risk Evaluation and Therapeutic Rationale

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Part of the book series: Contemporary Diabetes ((CDI))

Abstract

The widely prevailing diabetes pandemic has resulted in increased cardiovascular deaths over the last 50 years (Haffner et al., N Engl J Med 339(4):229–234, 1998). Established cross-sectional studies have remarked that an increase in glycosylated hemoglobin by 1 % is associated with upwards of a 20 % cardiovascular risk (Selvin et al., Ann Intern Med 141(6):421–431, 2004). Newly discovered and evolving relationships have shown sleep apnea and its cardiometabolic associations (Pandey et al., Curr Diab Rep 11(1):35–40, 2011), (Demede et al., Int J Hypertens 2011:340929, 2011) to have burdensome public health concerns and cost (Nieto et al., JAMA 283(14):1829–1836, 2000), (Peppard et al., N Engl J Med 342(19):1378–1384, 2000). There is also accumulating data suggesting the sleep apnea is involved in the pathogenesis of altered glucose metabolism independent of sociodemographic and medical comorbidities. The disastrous duo, diabetes and sleep apnea, have over encompassing mortality and morbidity and increased healthcare costs (Pandey et al., Curr Diab Rep 11(1):35–40, 2011).

We need to understand this is a mixed relationship, with an overlying role of obesity. None of the disease entities are independent of each other but are all intertwined into complex relationships that require multidisciplinary approach for prevention and treatment.

Hypertension is common among adults with obstructive sleep apnea (OSA) affecting up to 50 % of this group of patients. Hypertensive patients with OSA often have difficulty in controlling high blood pressure. Accordingly, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recognized OSA as a common secondary cause of hypertension. The American Heart Association also issued a Scientific Statement describing the need to recognize OSA as an important target for therapy in reducing cardiovascular risk.

Although several mechanisms have been suggested as possible links between hypertension and OSA, sustained adrenergic stimulation appears to be the most compelling pathophysiological link between the two. This chapter will discuss the pathophysiological and epidemiological data associating OSA with hypertension. Diagnosis and management of hypertension in OSA patients will also be discussed.

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Authors and Affiliations

  1. Department of Medicine, Sleep Disorder and Disparity Centers, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Abhishek Pandey, Monsur Adedayo, Ferdinand Zizi & Girardin Jean-Louis Ph.D.

  2. Division of Cardiology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Oladipupo Olafiranye

  3. Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, SUNY-Downstate and Kings County Hospital, Brooklyn, NY, USA

    Samy I. McFarlane M.D., M.P.H., M.B.A.

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  1. Abhishek Pandey
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  2. Oladipupo Olafiranye
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  3. Monsur Adedayo
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  4. Ferdinand Zizi
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  5. Samy I. McFarlane M.D., M.P.H., M.B.A.
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  6. Girardin Jean-Louis Ph.D.
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Correspondence to Girardin Jean-Louis Ph.D. .

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  1. County Hospital, Division of Endocrinology,, SUNY-Downstate and Kings, 450 Clarkson Ave., Brooklyn, 11203, New York, USA

    Samy I. McFarlane

  2. ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, 60637, Illinois, USA

    George L. Bakris

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Pandey, A., Olafiranye, O., Adedayo, M., Zizi, F., McFarlane, S.I., Jean-Louis, G. (2012). Diabetes and Hypertension in People with Sleep Apnea: Risk Evaluation and Therapeutic Rationale. In: McFarlane, S., Bakris, G. (eds) Diabetes and Hypertension. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-357-2_5

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