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Contemporary Reviews in Sleep Medicine |

Relationship Between OSA and HypertensionOSA and Hypertension

Gerard Torres, MD; Manuel Sánchez-de-la-Torre, PhD; Ferran Barbé, MD
Author and Funding Information

From the Respiratory Department (Drs Torres, Sánchez-de-la-Torre, and Barbé), Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (Drs Sánchez-de-la-Torre and Barbé), Madrid, Spain.

CORRESPONDENCE TO: Ferran Barbé, MD, Respiratory Department, Hospital Universitari Arnau de Vilanova, Rovira Roure, 80, 25198 Lleida, Spain; e-mail: febarbe.lleida.ics@gencat.cat


FUNDING/SUPPORT: This study was funded by Fondo de Investigación Sanitaria [PI10/02763, PI10/02745, and PI14/01266], the Spanish Respiratory Society (SEPAR), and Associació Lleidatana de Respiratori (ALLER).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):824-832. doi:10.1378/chest.15-0136
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There is a bidirectional association between OSA and systemic hypertension. The strengths of this relationship appear to be modulated by factors such as age, sex, and somnolence. The 24-h BP circadian pattern also appears to be influenced by OSA. Patients with this syndrome exhibit a high prevalence of nondipping or riser circadian patterns, which are related to clinical and subclinical organ damage in the heart and brain. However, the influence of OSA on nocturnal hypertension development has not yet been clarified. A special area of interest is the recognized relationship between OSA and resistant hypertension. The majority of patients with resistant hypertension suffer OSA. CPAP treatment significantly reduces BP in such patients and could play a clinical role in the management of BP in these patients. Several meta-analyses have demonstrated a concordant mild effect of CPAP on systemic hypertension. This effect is related to CPAP compliance, somnolence status, and baseline BP. The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials. In the absence of additional data reported by clinical studies on other antihypertensive drug treatments, diuretics, particularly antialdosteronic diuretic agents, should be considered the first-line antihypertensive drug treatment in patients with OSA. By reducing parapharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.

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