Canadian Journal of Cardiology

Hypertension and Sleep Apnea

  • John S. Floras
    Correspondence
    Corresponding author: Dr John S. Floras, Suite 1614, 600 University Ave, Toronto, Ontario M5G 1X5, Canada. Tel.: +1-416-586-8704; fax: +1-416-586-8702.
    Affiliations
    University Health Network and Mount Sinai Hospital Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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      Abstract

      Obstructive sleep apnea is more prevalent in patients with hypertension than in the general population and many with obstructive sleep apnea also have hypertension. Obstructive sleep apnea increases the risk of hypertension-related morbidities such as stroke, heart failure, and premature death. Are such associations coincidental or causal and if the latter, what are their implications for clinical practice? Despite compelling epidemiological and mechanistic links between obstructive sleep apnea and hypertension, the effect in clinical trials of the treatment of obstructive sleep apnea on blood pressure has been modest and variable. The purpose of this review is to summarize our present understanding of: (1) the relevant epidemiology and mechanisms that might be responsible for the bidirectional relationship between obstructive sleep apnea and hypertension; and (2) available evidence regarding the effect of treating obstructive sleep apnea on blood pressure.

      Résumé

      L’apnée obstructive du sommeil est plus répandue chez les patients souffrant d’hypertension que dans la population générale. De plus, beaucoup de patients souffrant d’apnée obstructive du sommeil souffrent également d’hypertension. L’apnée obstructive du sommeil augmente le risque de maladies liées à l’hypertension telles que l’accident vasculaire cérébral, l’insuffisance cardiaque et la mort prématurée. Ces associations sont-elles fortuites ou causales? Et si elles étaient causales, quelles sont ses conséquences sur la pratique clinique? En dépit des liens épidémiologiques et mécanistiques irréfutables entre l’apnée obstructive du sommeil et l’hypertension, les essais cliniques ont démontré que l’effet du traitement de l’apnée obstructive du sommeil sur la pression artérielle était modeste et variable. Le but de cette revue est de résumer notre compréhension actuelle de : 1) l’épidémiologie et des mécanismes pertinents qui seraient responsables de la relation bidirectionnelle entre l’apnée obstructive du sommeil et l’hypertension; 2) des données probantes disponibles concernant l’effet du traitement de l’apnée obstructive du sommeil sur la pression artérielle.
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