The Effect of Obstructive Sleep Apnea on Subclinical Target Organ Damage in Patients With Resistant Hypertension

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia Pub Date : 2025-03-01 DOI:10.1016/j.arbres.2024.07.018

Mireia Dalmases , Manuel Sánchez-de-la-Torre , Dolores Martinez , Olga Minguez , Rafaela Vaca , Lydia Pascual , Maria Aguilá , Esther Gracia-Lavedan , Ivan D. Benitez , Lucía Pinilla , Anunciación Cortijo , Clara Gort-Paniello , Ramon Bascompte Claret , Miguel Ángel Martinez-Garcia , Olga Mediano , Sofía Romero Peralta , Ana Maria Fortuna-Gutierrez , Paola Ponte Marquez , Luciano F. Drager , Mayara Cabrini , Gerard Torres

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Abstract

Introduction

Among all patients with hypertension, those with resistant hypertension (RH) have the highest rates of subclinical organ damage (SOD). The prevalence of obstructive sleep apnea (OSA) is high in RH patients, and it could contribute to SOD. We aimed to investigate how OSA and its treatment are related to SOD in a large cohort of RH patients.

Methods

This is an ancillary analysis to the SARAH study, a multicentre observational cohort aiming to evaluate the impact of OSA on RH. Individuals with RH who were undergoing a sleep study and have information on at least one of the SOD variables (vascular, cardiac or renal damage) were selected. Patients were followed-up for three years.

Results

In total, 503 subjects were included. The participants were predominantly male, obese, and the median (IQR) apnea–hypopnea index (AHI) was 15.5 (7.90–31.5) events/h. No differences in the presence of vascular or cardiac damage were observed between OSA and non-OSA patients. A lower estimated glomerular filtration rate (eGFR) was observed in participants with OSA than in those without OSA, with an adjusted effect of −8.69 mL/min/1.73 m² (−13.59, −3.79; p value < 0.001). Kidney damage was also greater in subjects with OSA, with an adjusted OR (95% CI) of 1.77 (1.09, 2.87; p value = 0.02). The eGFR showed a linear dose–response relationship with OSA severity. Among patients treated with CPAP, lower eGFR values were observed in noncompliant subjects.

Conclusions

OSA could contribute to worsening renal function in patients with RH. No compliance with CPAP was associated with lower values of eGFR.

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阻塞性睡眠呼吸暂停对难治性高血压患者亚临床靶器官损伤的影响

简介在所有高血压患者中，抵抗性高血压（RH）患者的亚临床器官损伤（SOD）发生率最高。阻塞性睡眠呼吸暂停（OSA）在抵抗性高血压患者中的发病率很高，这可能是导致 SOD 的原因之一。我们的目的是在一大批 RH 患者中调查 OSA 及其治疗与 SOD 的关系：这是 SARAH 研究的一项辅助分析，该研究是一项多中心观察性队列研究，旨在评估 OSA 对 RH 的影响。研究选取了正在接受睡眠研究且至少有一项SOD变量（血管、心脏或肾脏损伤）信息的RH患者。对患者进行了为期三年的随访：结果：共纳入 503 名受试者。参与者主要为男性、肥胖者，呼吸暂停-低通气指数（AHI）的中位数（IQR）为 15.5（7.90-31.5）次/小时。OSA患者与非OSA患者在血管或心脏损伤方面没有差异。与非 OSA 患者相比，OSA 患者的估计肾小球滤过率（eGFR）更低，调整后的影响值为-8.69mL/min/1.73m2（-13.59，-3.79；P 值）：OSA可能导致RH患者肾功能恶化。不使用 CPAP 与 eGFR 值降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archivos De Bronconeumologia Medicine-Pulmonary and Respiratory Medicine

CiteScore

3.50

自引率

17.50%

发文量

330

审稿时长

14 days

期刊介绍： Archivos de Bronconeumologia is a scientific journal that specializes in publishing prospective original research articles focusing on various aspects of respiratory diseases, including epidemiology, pathophysiology, clinical practice, surgery, and basic investigation. Additionally, the journal features other types of articles such as reviews, editorials, special articles of interest to the society and editorial board, scientific letters, letters to the editor, and clinical images. Published monthly, the journal comprises 12 regular issues along with occasional supplements containing articles from different sections. All manuscripts submitted to the journal undergo rigorous evaluation by the editors and are subjected to expert peer review. The editorial team, led by the Editor and/or an Associate Editor, manages the peer-review process. Archivos de Bronconeumologia is published monthly in English, facilitating broad dissemination of the latest research findings in the field.