The effect of high evening blood pressure on obstructive sleep apnea–related morning blood pressure elevation: does sex modify this interaction effect?
- Authors
- Han, S.-H.; Kim, H.J.; Lee, S.-A.
- Issue Date
- Dec-2019
- Publisher
- Springer Verlag
- Keywords
- Blood pressure; Diastolic blood pressure; Hypertension; Morning blood pressure; Obstructive sleep apnea; Sex
- Citation
- Sleep and Breathing, v.23, no.4, pp 1255 - 1263
- Pages
- 9
- Journal Title
- Sleep and Breathing
- Volume
- 23
- Number
- 4
- Start Page
- 1255
- End Page
- 1263
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/44989
- DOI
- 10.1007/s11325-019-01869-5
- ISSN
- 1520-9512
1522-1709
- Abstract
- Purpose: Obstructive sleep apnea (OSA) can lead to increased morning blood pressure (BP). We hypothesized that high evening BP may aggravate OSA-related morning BP elevation. Additionally, this interactional effect may be modified by sex. Methods: This retrospective, cross-sectional study included newly diagnosed OSA patients with an apnea-hypopnea index (AHI) ≥ 5 per hour on a full-night polysomnography. An analysis of covariance (ANCOVA) was used to determine whether severe OSA (AHI ≥ 30) was associated with higher morning BP than mild-to-moderate OSA (5 ≤ AHI < 30) and whether there was an interaction between apnea severity and evening BP on morning BP. To identify the sex effects, analyses were performed separately in each sex group. Results: A total of 1445 patients with an average age of 51.9 years (SD 11.7) (male 77.9% vs. female 22.1%; high evening BP group 22.4% vs. normal evening BP group 59.6%) were included in the study. Based on the ANCOVA, patients with severe OSA had significantly higher morning systolic BP (SBP) (p = 0.003), diastolic BP (DBP) (p < 0.001), and mean BP (MBP) (p < 0.001) than the mild-to-moderate group in male subjects. A significant interaction between apnea severity and evening BP was identified on morning DBP and MBP in male subjects. However, there were no differences in morning BP between severe and mild-to-moderate OSA groups in female subjects. Conclusions: In male subjects, severe OSA contributed to higher morning BP than mild-to-moderate OSA. OSA-associated morning BP elevation was more prominent in the high evening BP group than in the normal BP group. Such relations were not found in female subjects. © 2019, Springer Nature Switzerland AG.
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