title: Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study.
abstract: BACKGROUND
  Cross-sectional epidemiologic studies show an association between sleep-disordered breathing and hypertension, but only one cohort study has examined sleep-disordered breathing as a risk factor for incident hypertension.
  
  
  OBJECTIVE
  To examine whether sleep-disordered breathing increases the risk of incident hypertension among persons 40 years of age and older.
  
  
  METHODS
  In a prospective cohort study, we analyzed data from 2,470 participants who at baseline did not have hypertension, defined as blood pressure of at least 140/90 mm Hg or taking antihypertensive medication. The apnea-hypopnea index (AHI), the number of apneas plus hypopneas per hour of sleep, was measured by overnight in-home polysomnography. We estimated odds ratios for developing hypertension during 5 years of follow-up according to baseline AHI.
  
  
  RESULTS
  The odds ratios for incident hypertension increased with increasing baseline AHI; however, this relationship was attenuated and not statistically significant after adjustment for baseline body-mass index. Although not statistically significant, the observed association between a baseline AHI greater than 30 and future hypertension (odds ratio, 1.51; 95% confidence interval, 0.93-2.47) does not exclude the possibility of a modest association.
  
  
  CONCLUSIONS
  Among middle-aged and older persons without hypertension, much of the relationship between AHI and risk of incident hypertension was accounted for by obesity. After adjustment for body mass index, the AHI was not a significant predictor of future hypertension, although a modest influence of an AHI greater than 30 on hypertension could not be excluded.
authors.affiliation: Pulmonary Center, Boston University School of Medicine, 715 Albany St., Boston, MA 02118, USA. goconnor@bu.edu
authors.forename: George T
authors.initials: GT
authors.lastname: O'Connor
authors.forename: Brian
authors.initials: B
authors.lastname: Caffo
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.forename: David M
authors.initials: DM
authors.lastname: Rapoport
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Jonathan
authors.initials: J
authors.lastname: Samet
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D014481:United States / Q000453:epidemiology