SLEEP-DISORDERED BREATHING AND SYSTEMIC HYPERTENSION IN THE OLDER MALE

OBJECTIVE: To investigate the relationship between sleep-disordered br eathing (SDB) and essential hypertension in a population of older male hypertensives. PATIENTS: One-hundred forty consecutive older hyperten sive males. MEASUREMENTS: Monitoring of sleep-related breathing abnorm ality with a portable sleep apnea monitor (level III device). Assessme nt of complaints related to sleep quality using a validated questionna ire. Systemic arterial blood pressure according to WHO standards and b iochemical analyses. SDB was defined as more than 10 abnormal respirat ory events per hour of sleep. DESIGN: Prospective investigation on a r etrospective cohort. SETTING: Veterans Administrations hypertension cl inic. MAIN RESULTS: SDB was diagnosed in 80% of this older, hypertensi ve, male population, Thirty-four percent of all study subjects present ed with severe SDB, with more than 30 abnormal respiratory events per hour of sleep. Subjects with SDB were significantly heavier (BMI=30.0/-5.2 kg/m(2)) than subjects without SDB (BMI=26.8+/-5.1 kg/m(2), P=.0 04). Furthermore, subjects with SDB slept significantly longer (by a m ean of 46 minutes/night, P=.027) and complained significantly more oft en of daytime sleepiness than subjects without SDB (P=.018). Fifty per cent of all 140 subjects snored more than 10% of the total sleep time, and 26% snored for more than one-third of the night. No significant d ifferences in blood pressure values were observed in subjects with com pared with subjects without sleep-disordered breathing. However, a con siderable number of subjects presenting with hypertensive blood pressu re values despite treatment could be identified. Subjects presenting w ith hypertensive blood pressure Values had a significantly higher seve rity index of SDB than subjects with normotensive blood pressure value s (P=.047). CONCLUSIONS: This investigation supports data showing that undiagnosed SDB is a common phenomenon in older male individuals, lea ding to impaired daytime functioning and impairment of overall quality of life. More importantly, our data suggests that untreated SDB may h ave an adverse effect on the efficacy of antihypertensive treatment in hypertensive individuals with sleep-disordered breathing.