Back to Bibliography
Page
Age-Dependent Associations Between Sleep-Disordered Breathing and Hypertension:
Importance of Discriminating Between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension
in the Sleep Heart Health Study.
ABSTRACT
Background — Sleep-disordered breathing (SDB) is associated with hypertension
in the middle-aged. The association is less clear in older persons. Most middle-aged hypertensives have
systolic/diastolic hypertension, whereas isolated systolic hypertension (ISH) is common among persons over
60 years. Mechanistically, only systolic/diastolic hypertension is expected to be associated with SDB, but
few studies of SDB and hypertension distinguish systolic/diastolic hypertension from ISH. Prior investigations
may have underestimated an association between SDB and systolic/diastolic hypertension in the elderly by
categorizing individuals with ISH as simply hypertensive.
Methods and Results — We conducted cross-sectional analyses of 6120 participants in the Sleep Heart
Health Study, stratified by age: 40 to 59 (n=2477) and 60 years. Outcome measures included apnea-hypopnea
index (AHI; average number of apneas plus hypopneas per hour of sleep), systolic/diastolic hypertension
(140 and 90 mm Hg), and ISH (140 and <90 mm Hg). With adjustment for covariates, ISH was not associated with
SDB in either age category. In those aged<60 years, AHI was significantly associated with higher odds of
systolic/diastolic hypertension (AHI 15 to 29.9, OR=2.38 [95% CI 1.30 to 4.38]; AHI 30, OR=2.24 [95% CI 1.10
to 4.54]). Among those aged 60 years, no adjusted association between AHI and systolic/diastolic hypertension
was found.
Conclusions — SDB is associated with systolic/diastolic hypertension in those aged <60 years. No
association was found between SDB and systolic/diastolic hypertension in those aged 60 years or between SDB
and ISH in either age category. These findings have implications for SDB screening and treatment.
Distinguishing between hypertensive subtypes reveals a stronger association between SDB and hypertension for
those aged <60 years than previously reported.
Keywords: epidemiology • hypertension • risk factors • sleep apnea syndromes
