Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring

Author(s)

Genta-Pereira, Daniel Castanho ^{[1, 2]} ; Furlan, Sofia F. ^{[1, 2]} ; Omote, Daniel Q. ^[2] ; Giorgi, Dante M. A. ^[2] ; Bortolotto, Luiz A. ^[2] ; Lorenzi-Filho, Geraldo ^[3] ; Drager, Luciano F. ^{[2, 4]}

Affiliation

^[1] Univ Sao Paulo, Fac Med, Program Cardiol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Med Sch, Hypertens Unit, Heart Inst InCor, Ave Dr Eneas Carvalho de Aguiar 44, BR-05403900 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Med Sch, Sleep Lab, Pulm Div, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Med Sch, Hypertens Unit, Renal Div, Sao Paulo - Brazil

• Document type: Journal article
• Source: Hypertension; v. 72, n. 4, p. 979-985, OCT 2018.
• Web of Science Citations: 5

Abstract

A nondipping blood pressure (BP) pattern is common in patients with obstructive sleep apnea (OSA). However, it is unclear how useful a nondipping BP pattern is in screening for OSA. In this cross-sectional study, we recruited consecutive patients with clinical indications for performing ambulatory BP monitoring evaluating the following dipping patterns: (1) normal: 10% but <20%; (2) extreme: 20%; (3) reduced: 0% but <10%; and (4) reverse (riser): <0%. Sleep questionnaires and sleep studies were performed within 7 days after ambulatory BP monitoring. OSA was defined as an apnea-hypopnea index 15 events/h. We evaluated 153 patients (OSA frequency, 50.3%). Patients with OSA had higher BPs during sleep, were taking more antihypertensive drugs, and more frequently used hypertensive drugs during the night than patients without OSA. Considering systolic BP, the frequency of OSA in patients with reverse dippers (73.5%) was higher than normal (37.3%), extreme (46.2%), and reduced dippers (49.1%; P=0.012). For diastolic BP, OSA was more common in reduced (66.7%) and reverse dippers (69.6%) as compared to normal (41.4%) or extreme dippers (33.3%; P=0.007). In the regression analysis, reverse systolic dipper was independently associated with OSA (odds ratio, 3.92; 95% CI, 1.31-11.78). Both reduced and reverse diastolic dippers increased the likelihood of OSA for 2.7-fold and 3.5-fold, respectively. Snoring and positive sleep questionnaire findings were associated with a modest increase in the accuracy of reverse dipping pattern for predicting OSA. In conclusion, reverse systolic, as well as reduced and reverse diastolic dippers are independently associated with OSA. (AU)

• FAPESP's process: 12/02953-2 - Impact of obstructive sleep apnea and sleep duration on the progression of cardiovascular diseases
• Grantee: Luciano Ferreira Drager
• Support Opportunities: Research Grants - Young Investigators Grants