title: At 68 years, unrecognised sleep apnoea is associated with elevated ambulatory blood pressure.
abstract: After the age of 65 yrs the specific impact of unrecognised sleep-related breathing disorders (SRBD) on 24-h blood pressure (BP) levels remains under debate. We tested the cross-sectional relationship between the severity of obstructive sleep apnoea/hypopnoea (OSAH) and the increase of BP using ambulatory BP monitoring (ABPM) in the PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events study)-SYNAPSE (Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea study) cohort. 470 subjects (aged 68 yrs) neither treated for hypertension nor diagnosed for SRBD were included. All subjects underwent ABPM, and unattended at-home polygraphic studies. OSAH was defined by an apnoea/hypopnoea index (AHI) >15 · h(-1). The severity of the sleep apnoea was also quantified as the index of dips in oxyhaemoglobin saturation >3% (ODI). Results are expressed in per protocol analysis. Severe OSAH (AHI >30 · h(-1), 17% of subjects) was associated with a significant 5 mmHg increase in both diurnal and nocturnal systolic BP (SBP), and with a nocturnal 3 mmHg increase in diastolic BP (DBP). Systolic (mean SBP >135 mmHg) or diastolic (mean DBP >80 mmHg) hypertension were more frequently encountered in subjects suffering from moderate (AHI 15-30) or severe OSAH. After adjustment, the independent association between severe OSAH and 24-h systolic hypertension remained significant (OR 2.42, 95% CI 1.1-5.4). The relationship was further reinforced when SRBD severity was expressed using ODI >10 · h(-1). The impact of unrecognised SRBD on BP levels also exists at the age of 68 yrs. The hypoxaemic load appears to be the pathophysiological cornerstone for such a relationship.
authors.affiliation: Pole NOL et Service de Physiologie Clinique et de l'Exercice, CHU Nord, EA 4607 SNA EPIS, Faculté de Médecine Jaques Lisfranc, USM, PRES Université de Lyon, Saint-Etienne, France. Frederic.Roche@univ-st-etienne.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Roche
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
authors.forename: Emilie
authors.initials: E
authors.lastname: Achour-Crawford
authors.forename: Renaud
authors.initials: R
authors.lastname: Tamisier
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichot
authors.forename: Sébastien
authors.initials: S
authors.lastname: Celle
authors.forename: Delphine
authors.initials: D
authors.lastname: Maudoux
authors.forename: Florian
authors.initials: F
authors.lastname: Chouchou
authors.forename: Hourfil G
authors.initials: HG
authors.lastname: Ntougou-Assoumou
authors.forename: Patrick
authors.initials: P
authors.lastname: Lévy
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Barthélémy
mesh_terms: D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010100:Oxygen / Q000097:blood; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology
chemical_list: D010100:Oxygen