Systemic Hypertension in Snorers with and without Sleep Apnea

doi:10.1378/chest.102.2.367

Chest

Volume 102, Issue 2, August 1992, Pages 367-371

https://doi.org/10.1378/chest.102.2.367 Get rights and content

To investigate the impact of sleep-disordered breathing events on daytime hypertension (HT) in patients with increased upper airway resistance during sleep, we studied 191 male snorers aged 49.9 ±0.8 years. In 116 of them, an apnea-hypopnea index (AHI) above 10—defined as the presence of obstructive sleep apnea (OSA)—was found; the other 75 subjects had an AHI lower than 10 and were classified as habitual snorers (HSN). Prevalence of HT was not different between OSA (56 of 116 = 48 percent) and HSN (33 of 75=44 percent) and there was also no difference in systolic, diastolic, and mean blood pressures between the two groups. Hypertensive OSA patients had higher body mass index (BMI) than normotensive OSA subjects (31.4±0.7 vs 29.4±0.6; p<0.05), but there was no difference in age, AHI, and nocturnal oxygenation parameters. The same was true for the HSN group, with hypertensive subjects being more obese than normotensive subjects (BMI: 30 ±0.8 vs 27.3 ±0.8; p<0.05), but no difference in age and polysomnographic features. Discriminant analysis with HT as the classification variable and age, BMI, AHI, mean, and lowest nocturnal oxyhemoglobin saturation as independent variables, revealed an independent influence on HT only for BMI (F-prob = 0.001). Thus, our results stand against the hypothesis of a causal relationship between sleep-disordered breathing events and daytime hypertension. We conclude that the high prevalence of HT in male snorers is more directly linked to obesity than to sleep apnea, but an independent effect of snoring per se cannot be excluded.

Section snippets

MATERIALS AND METHODS

We studied 191 men aged 49.9 ±0.8 years. All of them had a history of loud snoring, which was the main reason for referral to the sleep laboratory in 84 of them. Apneas observed by their bed partners were reported by 115 of them, and 103 complained about excessive daytime sleepiness. A history of involuntarily falling asleep during the day was found in 116. All but 27 patients were above normal weight, ie, their body mass index (BMI) was higher than 25. Mean BMI of our study population was 29.6

RESULTS

In 116 of the 191 male snorers, an AHI above 10 was found, which was defined as the presence of OSA. The remaining 75 men with an AHI below 10 were classified as HSN. Mean AHI was 36.7±2.1 in the OSA group and 3.6 ±0.3 in the HSN group. The two groups did not differ in age (50.3 ±1 vs 49.3 ±1.2; p = 0.52), but OSA patients were more obese than the HSN group (BMI: 30.4 ±0.5 vs 28.5 ±0.6; p = 0.011).

A total of 102 subjects had neither elevated BP on examination nor a history of HT or

DISCUSSION

This study shows that daytime hypertension in male snorers does not depend on the occurrence of apneas during sleep. As we found equal prevalences of HT in snorers with AHI >10 and snorers with AHI <10 (48 percent vs 44 percent), our results do not support the hypothesis of a direct link between sleep apnea and hypertension. If OSA causes HT, one would expect that patients with more severe OSA are more prone to develop HT or show higher BPs than those with mild disease or only simple snoring,

REFERENCES (30)

GislasonT et al.
Prevalence of sleep apnea syndrome among Swedish men—an epidemiological study
J Clin Epidemiol
(1988)
LavieP et al.
Prevalence of sleep apnea syndrome among patients with hypertension
Am Heart J
(1984)
KalesA et al.
Sleep apnea in a hypertensive population
Lancet
(1984)
WilliamsAJ et al.
Sleep apnea syndromes and essential hypertension
Am J Cardiol
(1985)
HoffsteinV et al.
Determinants of blood pressure in snorers
Lancet
(1988)
EscourrouP et al.
Systemic hypertension in sleep apnea syndrome —relationship with sleep architecture and breathing abnormalities
Chest
(1990)
OparilS
The sympathetic nervous system in clinical and experimental hypertension
Kidney Int
(1986)
GuilleminaultC et al.
Snoring, I: daytime sleepiness in regular heavy snorers
Chest
(1991)
MillmanRP et al.
Daytime hypertension in obstructive sleep apnea: prevalence and contributing risk factors
Chest
(1991)
TilkianAG et al.
Hemodynamics in sleep-induced apnea studies during wakefulness and sleep
Ann Intern Med
(1976)

GuilleminaultC et al.

Clinical overview of the sleep apnea syndromes

BurachB et al.

The hypersomnia-sleep apnea syndrome: a reversible major cardiovascular hazard

Circulation

(1977)

LugaresiE et al.

Breathing during sleep in man in normal and pathological conditions

Adv Exp Med Biol

(1978)

FletcherEC et al.

Undiagnosed sleep apnea in patients with essential hypertension

Ann Intern Med

(1985)

KhatriIM et al.

Hemodynamic changes during sleep

J Appl Physiol

(1967)

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Unfortunately a good clinical history and clinical examination are sometimes overlooked, trusting too much the results of sleep recordings. Heavy habitual (every night) snoring (i.e., partial upper-airway obstruction), even without apneas, may influence pulmonary arterial pressure, and it is associated with daytime sleepiness, arterial hypertension, insulin resistance, metabolic syndrome and other health consequences (Lugaresi et al., 1975, 1983b; Partinen et al., 1983b, 1998; Koskenvuo et al., 1985b; Rauscher et al., 1992; Tiihonen et al., 1993; Martikainen et al., 1994; Grunstein et al., 1995; Grunstein, 1996; Young et al., 1996, 1997; Fuyuno et al., 1999; Hu et al., 1999, 2000; Bixler et al., 2000; Franklin et al., 2000; Lavie et al., 2000; Peppard et al., 2000; Leineweber et al., 2003). Sleep-related breathing disorders (SRBD) and sleep-disordered breathing (SDB) refer mostly to sleep apnea.
This chapter discusses the epidemiological principles and epidemiological figures of some common sleep disorders. Modern applications of epidemiology include the study of chronic diseases, the evaluation of health status and an evaluation of genetic and environmental factors associated with diseases or symptoms in defined populations. Epidemiological studies can be divided into descriptive, analytical, and intervention studies. Classic examples are cross-sectional studies with data collected at a defined moment and retrospective studies that are based on existing medical histories or other collected data. In descriptive studies, distribution is given with computations of statistical significance between different groups of subjects. Analytical or etiological studies allow more inferences to be done than descriptive studies, especially if the study has been prospective in time (longitudinal). Interventions are commonly used in clinical epidemiological research, e.g., to study the effect of a new hypnotic in insomnia, or to study the effect of weight loss in the treatment of sleep apnea. Ideally a randomized controlled trial (RCT) is designed.
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Our study aimed to determine the prevalence of habitual snoring (HS) in primary school children and to evaluate the diurnal symptoms and conditions that may be associated with it.
A validated questionnaire completed by parents was used to assess the sleep and daytime behaviors of Chinese children aged 5 to 14 years. Thirteen primary schools in two representative districts were randomly selected.
A total of 6,349 out of 9,172 questionnaires (response rate 69.2%) with complete answers were returned. The prevalence rate of HS was 7.2%. Male sex (odds ratio [OR] [95% CI]: 2.5 [1.7–3.6]), BMI z score (OR [95% CI]: 1.4 [1.1–1.6]), maternal HS (OR [95% CI]: 3.4 [2.0–5.7]), paternal HS (OR [95% CI]: 3.8 [2.7–5.5]), allergic rhinitis (OR [95% CI]: 2.9 [2.0–4.2]), asthma (OR [95% CI]: 2.4 [1.2–5.2]), nasosinusitis (OR [95% CI]: 4.0 [1.5–10.6]), and tonsillitis (OR [95% CI]: 3.1 [1.9–5.1]) in the past 12 months were identified to be independent risk factors associated with HS. HS was also associated with daytime, nocturnal, parasomniac, and sleep-related breathing symptoms. HS was demonstrated to be an independent risk factor for parent-reported poor temper (OR [95% CI]: 1.9 [1.4–2.5]), hyperactivity (OR [95%CI]: 1.7 [1.2–2.5]), and poor school performance (OR [95% CI]: 1.7 [1.2–2.5]).
HS was a significant and prevalent problem in primary school children. Male sex, obesity, parental HS, atopic symptoms, and history of upper respiratory infections were significant risk factors. HS was also associated with sleep-disordered breathing symptoms and adverse neurobehavioral outcomes.
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Obstructive sleep apnea (OSA) and stroke are common and serious multifactorial health problems that share many risk factors. Cohort studies have shown that some adult populations with severe OSA are at risk for “stroke.” Any given case usually has many “modifiable risk factors” for stroke that improve after OSA is successfully treated. To date, no double-blinded, randomized, controlled, treatment-versus-nontreatment trial has proved that OSA can cause stroke, and ethical constraints may prohibit such studies. Clinical trials are needed to assess the effectiveness of OSA treatment in improving stroke outcome. If treatment is proven to reduce morbidity and mortality significantly in a cost-effective manner, routine screening and more aggressive treatment options might become the standard of care for this patient population.
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2003, Chest
To examine the prevalence and correlates of habitual snoring in senior high school students in Korea.
A cross-sectional survey.
Ten high schools in the southern part of Seoul, Korea.
A total of 3,871 high school students (2,703 male students and 1,168 female students; age range, 15 to 18 years; mean age: male students, 16.8 years; female students, 16.9 years) who were attending the 11th grade.
Data were collected on sociodemographic characteristics, school performance, and patterns of sleep and sleep-related disturbances. The overall prevalence of habitual snoring was 11.2% (boys, 12.4%; girls, 8.5%). The mean total sleep time was similar in habitual snorers vs nonsnorers (6.4 and 6.3 h per day, respectively). Frequency of snoring increased significantly with body mass index (BMI) [p < 0.001], cigarette smoking (p < 0.01), prevalence of witnessed apnea (p < 0.001), and Epworth sleepiness scale score (p < 0.001). The frequency of snoring increased with a decline in school performance (p < 0.001). For those whose school performance was low, there was a 35% excess in the odds of habitual snoring vs those whose school performance was high (odds ratio, 1.35; 95% confidence interval, 1.01 to 1.78).
These findings suggest that chronic habitual snoring is associated with multiple factors in adolescents. Whether interventions to modify BMI and smoking can alter snoring habits and related clinical problems warrants further study, particularly as it also may improve academic performance in high school students.

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: Manuscript received July 18; revision accepted November 8.

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Chest

Clinical InvestigationsSystemic Hypertension in Snorers with and without Sleep Apnea

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

J Clin Epidemiol

Am Heart J

Lancet

Am J Cardiol

Lancet

Chest

Kidney Int

Chest

Chest

Hemodynamics in sleep-induced apnea studies during wakefulness and sleep

Ann Intern Med

Clinical overview of the sleep apnea syndromes

The hypersomnia-sleep apnea syndrome: a reversible major cardiovascular hazard

Circulation

Breathing during sleep in man in normal and pathological conditions

Adv Exp Med Biol

Undiagnosed sleep apnea in patients with essential hypertension

Ann Intern Med

Hemodynamic changes during sleep

J Appl Physiol

Clinical Investigations
Systemic Hypertension in Snorers with and without Sleep Apnea