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The Association of Hypertension and Secondary Cardiovascular Disease With Sleep-Disordered Breathing*
We present a review of the English-language literature from 1972 through 2000 pertaining to systemic high BP in patients with sleep-disordered breathing (SDB). We reviewed studies assessing the relationship between obstructive sleep apnea, central sleep apnea or periodic breathing, and systemic high BP, and present an approach to the management of these patients. Complications of obesity and the role of the sympathetic nervous system are reviewed as well. It is the aim of these reviews to draw qualified conclusions, based on the current literature, with regard to SDB as a causative or contributory factor in systemic hypertension.
(CHEST 2003; 123:244-260)
Key words: antihypertensive grugs; central sleep apnea; obstructive sleep apnea; periodic breathing; pulmonary disease; sleep-disordered breathing; systemic high BP
Abbreviations: AHI = apnea/hypopnea index; CPAP = continuous positive airway pressure; NREM = non-rapid eye movement; OSA = obstructive sleep apnea; RDI = respiratory disturbance index; REM = rapid eye movement; SDB = sleep-disordered breathing
Sleep-disordered breathing (SDB) is frequently found in conjunction with systemic hypertension. Determining cause and effect in that relationship has been very difficult to demonstrate. An association between systemic hypertension and SDB was first recognized in the 1970s by Coccagna et al,1 Lugaresi et al,2 and Motta et al3 in case reports of improvement in BP following surgical intervention for a variety of SDB problems. The authors raised the possibility of cause-and-effect relationship between SDB and systemic hypertension. Since the publication of those case reports, numerous studies have been conducted to try to confirm or clarify this relationship. The American College of Chest Physicians asked this panel to conduct a systematic and critical review of the literature, and to provide relevant conclusions regarding the evidence supporting SDB as a causative or contributory factor in systemic hypertension.
Several questions are addressed: Do patients with SDB have an increased incidence of systemic hypertension, and vice versa? Are there common factors to both, such as obesity, that contribute to the relationship? What is the role of the sympathetic nervous system? Does SDB treatment affect hypertension control? We report conclusions based on an extensive literature review covering studies performed from 1970 through 2000. We begin with definitions. We identify inconsistencies in the...