title: Resistant hypertension and obstructive sleep apnea in the setting of kidney disease.
abstract: OBJECTIVE
  To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD).
  
  
  METHODS
  We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90  mmHg despite at least three antihypertensive drugs.
  
  
  RESULTS
  Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2  mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix.
  
  
  CONCLUSIONS
  The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdel-Kader
authors.affiliation: West Virginia University School of Medicine, Morgantown, WV.
authors.forename: Sheena
authors.initials: S
authors.lastname: Dohar
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Shah
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Jhamb
authors.affiliation: Division of Cardiology, University of Pittsburgh, Pittsburgh PA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Strollo
authors.affiliation: Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Buysse
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D016022:Case-Control Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis
chemical_list: D000959:Antihypertensive Agents