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, Gregory L. Foster, F. Javier Nieto, Susan Redline, Helaine E. Resnick, John A Robbins, Terry Young, Thomas G. Pickering

Research output: Contribution to journalArticle

242 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)614-621
Number of pages8
JournalCirculation
Volume111
Issue number5
DOIs
StatePublished - Feb 8 2005

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Sleep Apnea Syndromes
Sleep
Hypertension
Health
Apnea

Keywords

  • Epidemiology
  • Hypertension
  • Risk factors
  • Sleep apnea syndromes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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. / Haas, Donald C.; Foster, Gregory L.; Nieto, F. Javier; Redline, Susan; Resnick, Helaine E.; Robbins, John A; Young, Terry; Pickering, Thomas G.

In: Circulation, Vol. 111, No. 5, 08.02.2005, p. 614-621.

Research output: Contribution to journalArticle

Haas, Donald C. ; Foster, Gregory L. ; Nieto, F. Javier ; Redline, Susan ; Resnick, Helaine E. ; Robbins, John A ; Young, Terry ; Pickering, Thomas G. / 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. In: Circulation. 2005 ; Vol. 111, No. 5. pp. 614-621.
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abstract = "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.",
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T1 - Age-dependent associations between sleep-disordered breathing and hypertension

T2 - Importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the sleep heart health study

AU - Haas, Donald C.

AU - Foster, Gregory L.

AU - Nieto, F. Javier

AU - Redline, Susan

AU - Resnick, Helaine E.

AU - Robbins, John A

AU - Young, Terry

AU - Pickering, Thomas G.

PY - 2005/2/8

Y1 - 2005/2/8

N2 - 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.

AB - 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.

KW - Epidemiology

KW - Hypertension

KW - Risk factors

KW - Sleep apnea syndromes

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U2 - 10.1161/01.CIR.0000154540.62381.CF

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