The Effect of Gender on Hypertension in OSAS Patients

Abstract

Objective: There are limited data about the effect of gender on the tension and rate pressure product (RPP) in patients with OSAS. The aim of the present study was to explore the effect of gender on hypertension (HT) and RPP in patients with OSAS. Methods: A diagnostic polysomnography was performed in all patients for overnight. OSAS diagnosed patients were included in this study. Sleep stages and respiratory events were manually scored. According to the findings of polysomnography, the effect of gender on tension in patients with OSAS was statistically analyzed. Results: Three hundred fourty seven patients consisting of 280 males and 67 females with OSAS were included in the present study. The mean age was 50±15 years in females and 48±12 years in males. The body mass index (BMI) was 28±6 kg/m2 in females and 28±5 kg/m2 in males. There was a positive correlation between the apnea/hypopnea index (AHI) with max systolic blood pressure (SBP) and RPP (p<0.01) in the male group, and a positive correlation between AHI with min PTT in the female group (p<0.01); however, there was no correlation between AHI and max SBP in females (p>0.05). Conclusion: The present study confirms previous findings of a relationship between obstructive sleep apnea with SBP. This relationship was evident in males but not identifiable in these females.These data suggest a possible gender difference in susceptibility to hypertension development in OSAS. Key words: Obstructive Sleep Apnea Syndrome, Hypertension, Gender Effect

Keywords

• Obstructive Sleep Apnea Syndrome, Hypertension, Gender Effect

OSAS’lı Hastalarda Cinsiyetin Hipertansiyon Üzerine Etkisi

Abstract

Amaç: Bu çalışmada OSAS'lı hastalarda hipertansiyon ve RPP (rate pressure product) üzerinde cinsiyetin etkilerini araştırmayı amaçladık. Metod: Tüm hastalara bir gece boyunca diagnostik polisomnografi uygıulandı. OSAS teşhisi konulan hastalar çalışmaya dahil edildi. Uyku süreçleri ve respiratuar durumlar polisomnografi bulgularına göre skorlandı. OSAS'lı hastalarda cinsiyetin tansiyon üzerindeki etkileri istatiksel olarak analiz edildi. Bulgular: Çalışmaya 280 erkek ve 67 kadın olmak üzere 347 hasta dahil edildi. Kadınlarda yaş ortalaması 50±15, erkeklerde 48±12'idi. Vücut kitle indeksi (The body mass index (BMI)) kadınlarda 28±6 kg/m² , erkeklerde 28±5 kg/m² olarak bulundu. Burada erkek gruplarında maksimum sistolik kan basıncı ve RPP ile AHI (apnea/hypopnea index) arasında pozitif bir ilişki (p<0.01), kadın gruplarında ise min PTT ile AHI arasında pozitif bir ilişki bulundu (p<0.01); ancak kadınlarda max SBP ile AHI arasında ilşki bulunamadı. Sonuç: Bu çalışma SBP ile obstruktif sleep apne arasındaki ilişkiye ilişkin önceki bulguları doğrulamaktadır. Bu ilişki erkeklerde açık olarak görülürken kadınlarda bulunamamıştır. Bu bilgiler OSAS'lı hastalarda hipertansiyona yatkınlıkta cinsiyet farklılıklarının etkisinin olası olduğunu göstermektedir. Anahtar kelimeler: Obstruktif Uyku Apnesi, Hipertansiyon, Cinsiyet Etkisi

Keywords

• Obstruktif Uyku Apnesi, Hipertansiyon, Cinsiyet Etkisi

References

1. Wolk R, Kara T, Somers VK. Sleep–disordered breathing and cardiovascular diseases. Circulation 2003;108:9-12.
2. Zwillich C, Sinoway L. Surges of muscle sympathetic nerve activity during obstructive apnea are linked to hypoxemia. J Appl Physiol 1995;79:581-88.
3. Somers VK, Kyken ME, Clary MP, Abbound FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-1904.
4. Jelic S, Bartels MN, Mateika JH, Ngai P, DeMeersman RE, Basner RC. Arterial stiffness increases during obstructive sleep apneas. Sleep 2002 ;25:15-20.
5. Lovett JK, Rothwell PM. Site of carotid plaque ulceration in relation to direction of blood flow: an angiographic and pathological study. Cerebrovasc Dis 2003; 16:369-75.
6. Silverberg DS, Oksenberg A. Are sleep related breathing disorders important contributing factors to the production of 2001;3:209-15.
7. Gobel FL, Norstrom LA, Nelson RR, Jorgensen CR, Wang Y. The rate–pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 1978; 57: 549– 56.
8. Rechtschaffen A. In AE Kales (ed). A Manual of Standardized Terminology, Techniques and Scoring Systems for Sleep Stages of Human Subjects. BIS/BRI UCLA, Los Angeles, CA;1968.

9. Thorpy M, Committee ftDCS. The International Classification of Sleep Disorders: Diagnostic and Coding Manuel. Rochester MN, American Sleep Disorders Association;1990.
10. Weber, Hypertension medicine. Totowa, N, J. Humana 2001.
11. YH Chan: Biostatistics Correlational Analysis. Singapore Med J 2003;44(12) : 614-19.
12. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52: 490-94.
13. Köhler U, Fus E, Grimm W, et al. Heart block in patients with obstructive sleep apnea: Pathogenetic factors and effects of treatment. Eur Respi J 1998;11:434-39.
14. Bayram NK, Çiftçi B, Güven SF, Bayram H, Diker E. Obstrüktif uyku apne sendromu şiddeti ile hipertansiyon arasındaki ilişki. Anadolu Kardiyol Derg 2007;7: 378-82
15. Lindberg E, Janson C, Gislason T, Svärdsudd K, Hetta J, Boman G. Snoring and hypertension: a 10 year follow up. Eur Respir J 1998;11:884-89.
16. Hedner J, Bengtsson-Boström K, Peker Y, Grote L, Råstam L, Lindblad U. Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case- control study. Eur Respir J. 2006;27(3):564-70.
17. Yukawa K, Inoue Y, Yagyu H, Hasegawa T, Komada Y, Namba K,Nagai N, Nemoto S, Sano E, Minoru M, at al.Gender Characteristics Obstructive Sleep Apnea Syndrome. Chest 2009;135:337- 43. in OSAS Patients With Japanese Patients
18. Henly PJ, George CF, Millar TW, Kryger MH. Heart rate response to breath-hold, valsalva and Mueller maneuvers in obstructive sleep apnea syndrome. Chest 1989;95;735- 39.
19. Hedner J, Ejnell H, Sellgren J, Hedner T, Wallin G. Is high and fluctuating muscle nerve sympathetic activity in the sleep apnoea syndrome of pathogenetic importance for the development of hypertension? J Hypertens Suppl. 1988;6(4):529-31.
20. Roche F, Court-Fortune I, Pichot V, Duverney D, Costes F, Emonot A, Vergnon J M, Geyssant A, Lacour J R.. Reduced cardiac sympathetic autonomic tone after long- term nasal continuous positive airway pressure in obstructive sleep apnoea syndrome. Clin Physiol 1999;19(2):127-134.
21. Philips B: Sleep-disordered breathing and cardiovascular disease. Sleep Med Rev 2005;9:131-140.
22. Roux F, Ambrosio CD, Mohsenin V. Sleep related breathing disoreders and cardiovascular diseases. Am J Med 2000;108:396-402.
23. Kim JS, Song WH, Shin C, Park CG, Seo HS, Shim WJ. The prevalence and awareness of hypertension and the relationship between hypertension and snoring in the Korean population. Korean J Intern Med 2001;16:62-68.
24. Mohsenin V, Yaggi HK, Shah N, Dziura J. The effect of gender on the prevalence of hypertension in obstructive sleep apnea. Sleep Med Aug 2009;10(7):759-62.
25. Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. J Hypertens 1990;8:941-46.
26. Kraiczi H, Peker Y, Caidahl K, Samuelsson A, Hedner J. Blood pressure, cardiac structure and severity of obstructive sleep apnea in a sleep clinic population. J Hypertens 2001;19: 2071-78.
27. Yakut T, Karkucak M, Ursavas A, Gulten T, Burgazlioglu B, Gorukmez O andKaradag M. Lack of association of ACE gene I/D polymorphism with obstructive sleep apnea syndrome in Turkish patients. Genetics and Molecular Research. 2010; 9 (2): 734-38.
28. Noda A, Okada T, Yasuma F, Nakashima N, Yokota M. Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 1995;107: 1538-44.
29. Corresponding author: Nadir KOÇAK, MD
30. Konya Education and Research Hospital, KONYA
31. Phone: [phone] 506 544 91 28
32. e-mail: [e-mail]