What is the association between sleep apnea and hypertension in younger patients?
Background: Younger patients with sleep apnea have a higher cardiovascular mortality rate compared with their normal counterparts. Because treating sleep apnea in hypertensive patients has been proven to reduce blood pressure, young patients with hypertension may be a good target screening population for sleep apnea.
Study design: Case control.
Setting: Department of Otorhinolaryngology-Head and Neck Surgery, Department of Internal Medicine, Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Hospital Outpatient Unit, Beserah Health Polyclinic, Kuantan, Pahang, Malaysia.
Synopsis: The study compared 120 hypertension participants aged 18 to 40 (mean age 27 years) with 120 non-hypertensive individuals as a control. Using the apnea-hypopnea index (AHI) as a marker for severity, the difference between the groups was significant in all severity grading but most pronounced at a threshold value of severe AHI. When using the desaturation index (DI) as a marker of severity, all the DI intervals tested were more prevalent in the hypertensive group. The patients with sleep apnea had more than twice the odds of comorbid sleep apnea than the patients without hypertension. Those with severe sleep apnea had nearly eight times the odds of having hypertension. This relation persisted even after adjustment for the effect of upper airway sizes and body mass index. Participants with severe obstructive sleep apnea were still 72 percent more likely to have hypertension.
The researchers found no evidence that tonsil size and nasopharyngeal collapse were important confounders. Noting that it remains a struggle to find a suitable cost-effective means of screening for sleep apnea in the general population, the authors concluded that screening for sleep apnea should be considered for young adults with hypertension.
Bottom line: Sleep apnea is associated with hypertension in young people aged 18 to 40 years and can influence clinical decision making regarding screening for sleep apnea in the younger population.
Reference: Asha’ari ZA, Hasmoni MH, Ab Rahman J, Yusof RA, Lope Ahmad RA. The association between sleep apnea and young adults with hypertension. Laryngoscope. 2012;122(10)2337-3242.