title: Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep.
abstract: Evidence linking OSA with hypertension in population studies is conflicting. We examined longitudinal and cross-sectional associations of previously unrecognized OSA, including OSA occurring in rapid eye movement (REM) sleep, with hypertension.
  
  
  
  The Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study is a longitudinal study of community-dwelling men in Adelaide, South Australia. Biomedical assessments at baseline (2002-2006) and follow-up (2007-2010) identified hypertension (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg, or medication) and risk factors. In 2010 to 2011, 837 men without a prior diagnosis of OSA underwent full in-home unattended polysomnography of whom 739 recorded ≥ 30 min of REM sleep. Hypertension at follow-up (concomitant with OSA status) was defined as prevalent hypertension. Recent-onset hypertension was defined as hypertension at biomedical follow-up (56 months mean follow-up [range, 48-74]) in men free of hypertension at baseline.
  
  
  
  Severe REM OSA (apnea hypopnea index ≥30/h) showed independent adjusted associations with prevalent (OR, 2.40, 95% CI, 1.42-4.06), and recent-onset hypertension (2.24 [1.04-4.81]). Significant associations with non-REM AHI were not seen. In men with AHI < 10, REM OSA (apnea hypopnea index) ≥ 20/h was significantly associated with prevalent hypertension (2.67 [1.33-5.38]) and the relationship with recent-onset hypertension was positive but not statistically significant (2.32 [0.79-6.84]). Similar results were seen when analyses were confined to men with non-REM AHI < 10.
  
  
  
  In men not considered to have OSA (AHI < 10), hypertension was associated with OSA during REM sleep. REM OSA may need consideration as an important clinical entity requiring treatment but further systematic assessment and evidence is needed.
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia. Electronic address: sarah.appleton@adelaide.edu.au.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.affiliation: Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia; The NHMRC Centres of Research Excellence, CIRUS and NEUROSLEEP, Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Martin
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Lang
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Catcheside
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D012895:Sleep, REM; D013021:South Australia / Q000453:epidemiology
keywords: epidemiology; hypertension; men; obstructive sleep apnea; rapid eye movement sleep