title: Obstructive sleep apnea during REM sleep and hypertension. results of the Wisconsin Sleep Cohort.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is associated with hypertension.
  
  
  OBJECTIVE
  We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension.
  
  
  METHODS
  We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification.
  
  
  RESULTS
  Fully adjusted models demonstrated significant dose-relationships between REM apnea-hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models.
  
  
  CONCLUSIONS
  Our findings indicate that REM OSA is cross-sectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.
authors.affiliation: 1 Sleep, Metabolism and Health Center, Department of Medicine.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Finn
authors.forename: Erika W
authors.initials: EW
authors.lastname: Hagen
authors.forename: Terry
authors.initials: T
authors.lastname: Young
authors.forename: Khin Mae
authors.initials: KM
authors.lastname: Hla
authors.forename: Eve
authors.initials: E
authors.lastname: Van Cauter
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D012895:Sleep, REM; D014922:Wisconsin / Q000453:epidemiology
keywords: REM-related sleep apnea; hypertension; obstructive sleep apnea; rapid eye movement; sleep-disordered breathing