College of Public Health and Human Sciences

Chapter Highlights

•Cross-sectional and prospective cohort studies in both population and clinical settings show an association between obstructive sleep apnea (OSA) and risk for systemic hypertension that appears to be independent of obesity, age, and other potential confounding factors.

•The strength, consistency, and dose-response relationship shown across studies suggest that the association is causal

•In support of a causal relationship, recent meta-analysis of randomized trials shows that treatment with positive airway pressure results in a reduction of blood pressure among hypertensive patients with OSA that is likely to be of clinical and therapeutic significance. This effect is most pronounced in patient with baseline elevated blood pressure, those who have severe OSA, and those who are adherent to therapy.

•Using the current definition of pulmonary hypertension, about 10% of patients with OSA have mean pulmonary artery pressure of 25mmHg or greater. Mild pulmonary arterial hypertension may occur in patients with OSA without daytime hypoxemia or chronic obstructive pulmonary disease, although pulmonary hypertension could be more severe in the presence of chronic lung disease, heart failure, and obesity hypoventilation.

•Studies, mostly observational, suggest that treatment of OSA improves pulmonary hypertension.