Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring

摘要

A nondipping blood pressure (BP) pattern is common in patients with obstructive sleep apnea (OSA). However,it is unclear how useful a nondipping BP pattern is in screening for OSA. In this cross-sectional study, we recruitedconsecutive patients with clinical indications for performing ambulatory BP monitoring evaluating the following dippingpatterns: (1) normal: ≥10% but <20%; (2) extreme: ≥20%; (3) reduced: ≥0% but <10%; and (4) reverse (riser): <0%.Sleep questionnaires and sleep studies were performed within 7 days after ambulatory BP monitoring. OSA was definedas an apnea-hypopnea index ≥15 events/h. We evaluated 153 patients (OSA frequency, 50.3%). Patients with OSA hadhigher BPs during sleep, were taking more antihypertensive drugs, and more frequently used hypertensive drugs duringthe night than patients without OSA. Considering systolic BP, the frequency of OSA in patients with reverse dippers(73.5%) was higher than normal (37.3%), extreme (46.2%), and reduced dippers (49.1%; P=0.012). For diastolic BP,OSA was more common in reduced (66.7%) and reverse dippers (69.6%) as compared to normal (41.4%) or extremedippers (33.3%; P=0.007). In the regression analysis, reverse systolic dipper was independently associated with OSA(odds ratio, 3.92; 95% CI, 1.31–11.78). Both reduced and reverse diastolic dippers increased the likelihood of OSAfor 2.7-fold and 3.5-fold, respectively. Snoring and positive sleep questionnaire findings were associated with a modestincrease in the accuracy of reverse dipping pattern for predicting OSA. In conclusion, reverse systolic, as well as reducedand reverse diastolic dippers are independently associated with OSA.