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(Circulation. 2005;111:614-621.)
© 2005 American Heart Association, Inc.

Hypertension

Age-Dependent Associations Between Sleep-Disordered Breathing and Hypertension

Importance of Discriminating Between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study

Donald C. Haas, MD, MPH; Gregory L. Foster, MA; F. Javier Nieto, MD, PhD; Susan Redline, MD, MPH; Helaine E. Resnick, PhD, MPH; John A. Robbins, MD, MHS; Terry Young, PhD; Thomas G. Pickering, MD, DPhil

From Mount Sinai School of Medicine (D.C.H.), New York, NY; Johns Hopkins University (G.L.F.), SHHS Coordinating Center, Baltimore, Md; University of Wisconsin Medical School (F.J.N., T.Y.), Madison, Wis; Case Western Reserve University and Rainbow Babies and Children’s Hospital (S.R.), Cleveland, Ohio; MedStar Research Institute (H.E.R.), Hyattsville, Md; University of California at Davis (J.A.R.), Sacramento, Calif; and Columbia University (T.G.P.), College of Physicians and Surgeons, Department of Medicine, New York, NY.

Correspondence to Thomas G. Pickering, MD, DPhil, Columbia University, College of Physicians and Surgeons, Department of Medicine, 622 W 168th St, PH9-946, New York, NY 10032. E-mail tp2114{at}columbia.edu

Received May 21, 2004; revision received October 21, 2004; accepted October 29, 2004.

Background— Sleep-disordered breathing (SDB) is associated with hypertension in the middle-aged. The association is less clear in older persons. Most middle-aged hypertensives have systolic/diastolic hypertension, whereas isolated systolic hypertension (ISH) is common among persons over 60 years. Mechanistically, only systolic/diastolic hypertension is expected to be associated with SDB, but few studies of SDB and hypertension distinguish systolic/diastolic hypertension from ISH. Prior investigations may have underestimated an association between SDB and systolic/diastolic hypertension in the elderly by categorizing individuals with ISH as simply hypertensive.

Methods and Results— We conducted cross-sectional analyses of 6120 participants in the Sleep Heart Health Study, stratified by age: 40 to 59 (n=2477) and 60 years. Outcome measures included apnea-hypopnea index (AHI; average number of apneas plus hypopneas per hour of sleep), systolic/diastolic hypertension (140 and 90 mm Hg), and ISH (140 and <90 mm Hg). With adjustment for covariates, ISH was not associated with SDB in either age category. In those aged<60 years, AHI was significantly associated with higher odds of systolic/diastolic hypertension (AHI 15 to 29.9, OR=2.38 [95% CI 1.30 to 4.38]; AHI 30, OR=2.24 [95% CI 1.10 to 4.54]). Among those aged 60 years, no adjusted association between AHI and systolic/diastolic hypertension was found.

Conclusions— SDB is associated with systolic/diastolic hypertension in those aged <60 years. No association was found between SDB and systolic/diastolic hypertension in those aged 60 years or between SDB and ISH in either age category. These findings have implications for SDB screening and treatment. Distinguishing between hypertensive subtypes reveals a stronger association between SDB and hypertension for those aged <60 years than previously reported.

Key Words: epidemiology • hypertension • risk factors • sleep apnea syndromes

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