Prevalence of sleep apnea syndrome among patients with essential hypertension

doi:10.1016/0002-8703(84)90628-8

American Heart Journal

Volume 108, Issue 2, August 1984, Pages 373-376

https://doi.org/10.1016/0002-8703(84)90628-8 Get rights and content

Abstract

The purpose of this study was to investigate the prevalence of sleep apnea syndrome (SAS) among patients with essential hypertension. Sixteen of 50 patients with essential hypertension were suspected of having SAS based on their responses to a sleep questionnaire. Whole-night polysomnographic recordings revealed that 11 of the 16 patients, which is 22% of the initial sample, had SAS as defined by the occurrence of at least 10 apneas lasting 10 seconds each per hour of polygraphically defined sleep. The preponderant finding of SAS in this group indicates that the possibility of the syndrome should be taken into consideration in the clinical evaluation of these patients.

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Obstructive sleep apnoea syndrome (OSAS) is a frequent sleep disorder that is known to be an independent risk factor for arterial hypertension (AHT). Potential confounding factors associated with both OSAS and AHT, such as age, diabetes mellitus and obesity, have been explored extensively, and are considered as independent but additive factors. However, these factors are also contributors to left ventricular (LV) hypertrophy (LVH) and LV diastolic dysfunction, both of which are important causes of cardiovascular morbidity, and have been reported to be associated with OSAS for decades. In this review, we present an overview of how OSAS may promote changes in LV geometry and diastolic dysfunction through its best-known cardiovascular complication, arterial hypertension. We also summarize the epidemiological links between OSAS and LVH, outline diastolic dysfunction in OSAS patients, and try to highlight the mechanisms responsible, focusing on the effect of confounding factors.
Le syndrome d’apnées du sommeil obstructif (SASO) est un trouble du sommeil fréquent, et un important facteur de risque d’hypertension artérielle (HTA). Les potentiels facteurs confondants associés au SASO ainsi qu’à l’HTA, comme l’âge, le diabète, et l’obésité, ont été largement explorés et sont aujourd’hui considérés comme des facteurs indépendants mais additionnels. De plus, ces facteurs contribuent à la survenue d’hypertrophie ventriculaire gauche et de dysfonction diastolique, deux conditions associées à une forte morbi-mortalité cardiovasculaire et associées au SASO depuis des décennies. Cette revue présente une vue d’ensemble des effets du SASO sur la géométrie ventriculaire gauche et sa fonction diastolique par sa principale complication cardiovasculaire qu’est l’HTA. Nous résumons les liens épidémiologiques entre SASO et HVG, décrivons la fonction diastolique dans le SASO, et présentons les mécanismes physiopathologiques impliqués en tenant compte des facteurs confondants.
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Le syndrome d’apnée du sommeil (SAS) est très peu décrit chez l’hypertendu noir africain.
De dépister le syndrome d’apnées du sommeil à l’aide de l’échelle d’évaluation de somnolence diurne d’Epworth et de rechercher les déterminants afin d’en déduire les conséquences thérapeutiques.
Étude rétrospective et prospective à visée descriptive et analytique ayant concerné 200 hypertendus suivis en consultation externe de l’institut de cardiologie d’Abidjan. Le critère principal étudié était le SAS. L’approche diagnostique du SAS a été effectuée à l’aide de l’échelle de somnolence diurne d’Epworth.
La prévalence de l’apnée du sommeil était de 45 %. L’âge moyen des porteurs d’apnées du sommeil était de 56,1 ans, avec une prédominance du genre masculin (60 %). Les facteurs déterminants du syndrome d’apnée du sommeil étaient le genre masculin (60 % versus 40 % ; p = 0,021), l’obésité (77,8 % versus 62,7 % ; p < 0,0001), le diabète (26,7 % versus 15,5 % ; p = 0,5), la dyslipidémie (54,4 % versus 27,3 % ; p = 0,0009). La vie en agglomération, la profession et le tabagisme n’étaient pas corrélés au SAS dans notre série. Le contrôle de l’HTA a été meilleur chez les non-apnéiques par rapport aux apnéiques (63,6 % versus 38,9 % ; p = 0,04). Le retentissement viscéral de l’HTA chez les apnéiques a été fortement significatif (77,8 % versus 41,7 % ; p = 0,014). Au plan thérapeutique, il a été constaté la prescription préférentielle de la plurithérapie chez les apnéiques par rapport aux non-apnéiques (82,3 % versus 74,4 %).
Sleep apnea syndrome (SAS) is very little described in the hypertensive black African.
To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences.
This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness.
The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P = 0.021), obesity (77.8% versus 62.7%, P < 0.0001), diabetes (26.7% versus 15.5%, P = 0.5) and dyslipidemia (54.4% versus 27.3%, P = 0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P = 0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P = 0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).
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Prevalence of sleep apnea syndrome among patients with essential hypertension

Abstract

The sleep apnea syndromes

Ann Rev Med

Sleep apnea in industrial workers

Apneic and nonapneic breathing disorders in sleep

Isr J Med Sci

Incidence of sleep apnea in a presumably healthy working population. A significant relationship with excessive daytime sleepiness

Sleep

Sleep habits and sleep disturbances in industry workers in Israel: Main findings and some characteristics of workers complaining of EDS

Sleep

Snoring and its clinical implications

Arterial hypertension and ischemic heart disease—prevalence aspects