Chest
Volume 125, Issue 3, March 2004, Pages 817-822
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Clinical Investigations
CARDIOLOGY
White Coat Hypertension in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome

https://doi.org/10.1378/chest.125.3.817Get rights and content

Background

The strength of the association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and systemic hypertension could be affected by methodologic problems in the definition of hypertension.

Study objectives

To determine the frequency of white coat hypertension (WCH) in patients with OSAHS, and to analyze the characteristics of patients with OSASH and WCH.

Patients and interventions

Ninety-nine consecutive patients with OSAHS and 20 healthy control subjects were included into the study. Twenty-four-hour ambulatory BP monitoring (ABPM) and urinary catecholamines were determined simultaneously with the polysomnographic study. Arterial blood gases and lung volumes were also measured.

Results

Office hypertension was diagnosed in 45 patients, while the control group included 54 normotensive patients with OSAHS. After ABPM, hypertension was confirmed in 30 patients with OSAHS and office hypertension. WCH was diagnosed in the remaining 15 patients (33%). Patients with WCH presented higher values of sleep onset latency and wake after sleep onset than normotensive and sustained hypertensive patients. No other differences in sleep parameters, function tests, or urinary catecholamines were found between the OSAHS groups.

Conclusion

The results indicate that WCH is a frequent phenomenon in patients with OSAHS, and that it is not predictable by clinical variables.

Section snippets

Subjects

Ninety-six consecutive patients with OSAHS were selected for study. Patients were excluded from the study for the following reasons: (1) unwillingness or inability to perform the testing procedure; (2) obstructive or restrictive lung disease demonstrated on pulmonary function testing; (3) congestive heart failure, valvular heart disease, or atrial fibrillation; (4) suspected secondary hypertension; (5) current drug or mechanical treatment for sleep apnea; (6) therapy with steroids, nonsteroidal

Results

Office hypertension was diagnosed in 45 patients with OSAHS. Thirty-five of these subjects were in World Health Organization hypertension stage 1 (systolic BP < 159 mm Hg, diastolic BP < 99 mm Hg), 8 patients were in stage 2 (systolic BP, 160 to 179 mm Hg/diastolic BP, 100 to 109 mm Hg), and 2 patients were in stage 3 (systolic BP > 180 mm Hg/diastolic BP >110 mm Hg). The normotensive OSAHS group was composed of 54 patients. After ABPM determination, hypertension was confirmed in 30 patients

Discussion

This study, the first to our knowledge to analyze the WCH phenomenon in patients with OSAHS, showed that one third of these patients, diagnosed hypertensives with office BP measurements, presented WCH. Although published estimates vary widely, WCH has been reported to occur in approximately 30% of hypertensive patients.212223 The highest prevalence of WCH has been described in diabetic patients. In patients with type 2 diabetes mellitus, prevalence of WCH ranges from 23 to 62%, and reaches 74%

ACKNOWLEDGMENT

The investigators thank A. Alvarez, P. Librán, A. Pérez, and C. Suárez for technical assistance.

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    Supported by grants 96/1280 and 99/0252 from Fondo de Investigación Sanitaria, and Neumomadrid (2000).

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