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Obstructive sleep apnea in relation to beat-to-beat, reading-to-reading, and day-to-day blood pressure variability

Hypertension Research volume 47, pages 1391–1400 (2024)Cite this article

Abstract

We investigated blood pressure (BP) variability as assessed by beat-to-beat, reading-to-reading and day-to-day BP variability indices in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). In 786 hospitalized hypertensives (mean age, 53.2 years; 42.2% women), we performed 10-min beat-to-beat (n = 705), 24-h ambulatory (n = 779), and 7-day home BP (n = 445) measurements and the full overnight polysomnography. Mild, moderate and severe OSAHS were defined as an apnea-hypopnea index of 5–14, 15–29, and ≥ 30 events per hour, respectively. BP variability indices including variability independent of the mean (VIM), average real variability (ARV), and maximum–minimum difference (MMD), were compared across the OSAHS severity groups. In univariate analysis, beat-to-beat systolic VIM and MMD, reading-to-reading asleep systolic and diastolic ARV and MMD increased from patients without OSAHS, to patients with mild, moderate and severe OSAHS. This increasing trend for beat-to-beat systolic VIM and MMD remained statistically significant after adjustment for confounders (P ≤ 0.047). There was significant (P ≤ 0.039) interaction of the presence and severity of OSAHS with age and body mass index in relation to the beat-to-beat systolic VIM and MMD and with the presence of diabetes mellitus in relation to asleep systolic ARV. The association was stronger in younger (age < 50 years) and obese (body mass index ≥ 28 kg/m²) and diabetic patients. None of the day-to-day BP variability indices reached statistical significance (P ≥ 0.16). BP variability, in terms of beat-to-beat systolic VIM and MMD and asleep reading-to-reading asleep systolic ARV, were higher with the more severe OSAHS, especially in younger and obese and diabetic patients.

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Acknowledgements

The authors gratefully acknowledge the voluntary participation of all study participants and the expert technical assistance of Yu-Ting Jiang, Bang-Qing Xiao, Jun-Wei Li, Bei-Wen Lv (Shanghai Institute of Hypertension, Shanghai, China).

Funding

The study investigators were financially supported by grants from the National Natural Science Foundation of China (82070432, 82070435, 82270469, and 82370426), and Ministry of Science and Technology (2018YFC1704902 and 2022YFC3601302), Beijing, China, from the Shanghai Commissions of Science and Technology (grant 19DZ2340200, 22S31905100), and Health (grant 20234Y0036, “Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System” GWV-10.1-XK05 and a special grant for “leading academics”), Shanghai, China, and from the Clinical Research Program, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (grant 2018CR010), Shanghai, China.

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  1. These authors contributed equally: Yi-Bang Cheng, Qian-Hui Guo.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yi-Bang Cheng, Qian-Hui Guo, Jia-Hui Xia, Jin Zhang, Ting-Yan Xu, Yan Li & Ji-Guang Wang

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Correspondence to Ting-Yan Xu.

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Cheng, YB., Guo, QH., Xia, JH. et al. Obstructive sleep apnea in relation to beat-to-beat, reading-to-reading, and day-to-day blood pressure variability. Hypertens Res 47, 1391–1400 (2024). https://doi.org/10.1038/s41440-024-01628-4

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