Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling.
OBJECTIVE
Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure.


METHODS
We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index.


RESULTS
Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001).


CONCLUSIONS
Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.
Drager
Luciano F
LF
Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas Carvalho de Aguiar 44, CEP 05403-904, São Paulo, Brazil.
Bortolotto
Luiz A
LA
Figueiredo
Adelaide C
AC
Silva
Bruno Caldin
BC
Krieger
Eduardo M
EM
Lorenzi-Filho
Geraldo
G
D000328:Adult; D001158:Arteries / Q000473:pathology*; D001783:Blood Flow Velocity; D018450:Disease Progression; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology; D020257:Ventricular Remodeling