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Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps

Journal of Human Hypertension volume 35, pages 315–324 (2021)Cite this article

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Abstract

Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent collapse of the upper airway during sleep, resulting in partial (hypopnoeas) and total obstructions (apneas). These respiratory events observed in OSA may trigger multiple pathways involved in the blood pressure (BP) instability during the night and potentially influencing daytime BP as well (carry-over effects). This review provides an update about the impact of OSA and its treatments on 24-h BP control. Overall, there is growing evidence suggest that OSA is associated with higher frequency of nondipping BP pattern and nocturnal hypertension in a dose-dependent manner. The presence of nondiping BP (especially the reverse pattern) is independently associated with OSA regardless of sleep-related symptoms suggesting a potential tool for screening OSA in patients with clinical indication for performing ABPM. Beyond dipping BP, preliminary evidence associated OSA with white-coat effect and higher frequency of masked hypertension and BP variability than the control group (no OSA). Unfortunately, most of the evidence on the evidence addressing the impact of OSA treatment on BP was limited to office measurements. In the last years, data from observational and randomized studies pointed that CPAP is able to promote 24-h BP decrease especially in patients with resistant and refractory hypertension. A randomized trial suggests that CPAP is able to decrease the rate of masked hypertension as compared to no treatment in patients with severe OSA. Interestingly, nondipping BP is a good predictor of BP response to CPAP making ABPM an interesting tool for better OSA management.

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Fig. 1: Frequency of the different patterns of blood pressure (BP) dipping according to the Obstructive Sleep Apnea (OSA) status in 153 consecutive patients with clinical indications for performing ambulatory blood pressure monitoring (ABMP).
Fig. 2: Regression analysis to evaluate independent systolic blood pressure (BP) dipping patterns associated with obstructive sleep apnea (OSA).
Fig. 3: Adjusted receiver operating characteristic (ROC) curves for reverse dipper (systolic blood pressure) alone or combined with traditional questionnaires for screening obstructive sleep apnea (OSA).
Fig. 4: Change in night-time blood pressure (BP) after continuous positive airway pressure (CPAP) treatment in patients stratified by circadian BP pattern and night-time heart rate at baseline.

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  1. Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil

    Andrea Pio-Abreu & Luciano F. Drager

  2. Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil

    Heitor Moreno Jr

  3. Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil

    Luciano F. Drager

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Pio-Abreu, A., Moreno, H. & Drager, L.F. Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps. J Hum Hypertens 35, 315–324 (2021). https://doi.org/10.1038/s41371-020-00470-8

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