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Sleep apnoea and hypertension: proof at last?
  1. J R Stradling,
  2. J C T Pepperell,
  3. R J O Davies
  1. Oxford Centre for Respiratory Medicine, Oxford Radcliffe Trust, Oxford OX3 7LJ, UK
  1. Professor J Stradlingjohn.stradling{at}ndm.ox.ac.uk

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Introductory article

Prospective study of the association between sleep-disordered breathing and hypertension

P E Peppard, T Young, M Palta, J Skatrud

Background: Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the association between objectively measured sleep-disordered breathing and hypertension (defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications). Methods: We analyzed data on sleep-disordered breathing, blood pressure, habitus, and health history at baseline and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study (and after eight years of follow-up in the case of 184 of these participants). Participants were assessed overnight by 18-channel polysomnography for sleep-disordered breathing, as defined by the apnea-hypopnea index (the number of episodes of apnea and hypopnea per hour of sleep). The odds ratios for the presence of hypertension at the four-year follow-up study according to the apnea-hypopnea index at baseline were estimated after adjustment for baseline hypertension status, body-mass index, neck and waist circumference, age, sex, and weekly use of alcohol and cigarettes. Results: Relative to the reference category of an apnea-hypopnea index of 0 events per hour at base line, the odds ratios for the presence of hypertension at follow-up were 1.42 (95% CI 1.13 to 1.78) with an apnea-hypopnea index of 0.1 to 4.9 events per hour at baseline as compared with none, 2.03 (95% CI 1.29 to 3.17) with an apnea-hypopnea index of 5.0 to 14.9 events per hour, and 2.89 (95% CI 1.46 to 5.64) with an apnea-hypopnea index of 15.0 or more events per hour. Conclusions: We found a dose-response association between sleep-disordered breathing at baseline and the presence of hypertension four years later that was independent of …

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