npj Digital Medicine (Mar 2023)

High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension

  • Bastien Lechat,
  • Kelly A. Loffler,
  • Amy C. Reynolds,
  • Ganesh Naik,
  • Andrew Vakulin,
  • Garry Jennings,
  • Pierre Escourrou,
  • R. Doug McEvoy,
  • Robert J. Adams,
  • Peter G. Catcheside,
  • Danny J. Eckert

DOI
https://doi.org/10.1038/s41746-023-00801-2
Journal volume & issue
Vol. 6, no. 1
pp. 1 – 8

Abstract

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Abstract Obstructive sleep apnea (OSA) severity can vary markedly from night-to-night. However, the impact of night-to-night variability in OSA severity on key cardiovascular outcomes such as hypertension is unknown. Thus, the primary aim of this study is to determine the effects of night-to-night variability in OSA severity on hypertension likelihood. This study uses in-home monitoring of 15,526 adults with ~180 nights per participant with an under-mattress sleep sensor device, plus ~30 repeat blood pressure measures. OSA severity is defined from the mean estimated apnea–hypopnoea index (AHI) over the ~6-month recording period for each participant. Night-to-night variability in severity is determined from the standard deviation of the estimated AHI across recording nights. Uncontrolled hypertension is defined as mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg. Regression analyses are performed adjusted for age, sex, and body mass index. A total of 12,287 participants (12% female) are included in the analyses. Participants in the highest night-to-night variability quartile within each OSA severity category, have a 50–70% increase in uncontrolled hypertension likelihood versus the lowest variability quartile, independent of OSA severity. This study demonstrates that high night-to-night variability in OSA severity is a predictor of uncontrolled hypertension, independent of OSA severity. These findings have important implications for the identification of which OSA patients are most at risk of cardiovascular harm.