Ra. Stoohs et al., SLEEP-DISORDERED BREATHING AND SYSTEMIC HYPERTENSION IN THE OLDER MALE, Journal of the American Geriatrics Society, 44(11), 1996, pp. 1295-1300
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.