Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension

doi:10.1056/NEJM200005113421901

Volume 342:1378-1384		May 11, 2000		Number 19

Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension

Paul E. Peppard, Ph.D., Terry Young, Ph.D., Mari Palta, Ph.D., and James Skatrud, M.D.

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ABSTRACT

Background Sleep-disordered breathing is prevalent in the generalpopulation and has been linked to chronically elevated bloodpressure in cross-sectional epidemiologic studies. We performeda prospective, population-based study of the association betweenobjectively measured sleep-disordered breathing and hypertension(defined as a laboratory-measured blood pressure of at least140/90 mm Hg or the use of antihypertensive medications).

Methods We analyzed data on sleep-disordered breathing, bloodpressure, habitus, and health history at base line and afterfour years of follow-up in 709 participants of the WisconsinSleep Cohort Study (and after eight years of follow-up in thecase of 184 of these participants). Participants were assessedovernight by 18-channel polysomnography for sleep-disorderedbreathing, as defined by the apnea–hypopnea index (thenumber of episodes of apnea and hypopnea per hour of sleep).The odds ratios for the presence of hypertension at the four-yearfollow-up study according to the apnea–hypopnea indexat base line were estimated after adjustment for base-line hypertensionstatus, body-mass index, neck and waist circumference, age,sex, and weekly use of alcohol and cigarettes.

Results Relative to the reference category of an apnea–hypopneaindex of 0 events per hour at base line, the odds ratios forthe presence of hypertension at follow-up were 1.42 (95 percentconfidence interval, 1.13 to 1.78) with an apnea–hypopneaindex of 0.1 to 4.9 events per hour at base line as comparedwith none, 2.03 (95 percent confidence interval, 1.29 to 3.17)with an apnea–hypopnea index of 5.0 to 14.9 events perhour, and 2.89 (95 percent confidence interval, 1.46 to 5.64)with an apnea–hypopnea index of 15.0 or more events perhour.

Conclusions We found a dose–response association betweensleep-disordered breathing at base line and the presence ofhypertension four years later that was independent of knownconfounding factors. The findings suggest that sleep-disorderedbreathing is likely to be a risk factor for hypertension andconsequent cardiovascular morbidity in the general population.

Source Information

From the Departments of Preventive Medicine (P.E.P., T.Y., M.P.), Medicine (J.S.), and Biostatistics and Medical Informatics (M.P.), University of Wisconsin School of Medicine, Madison.

Address reprint requests to Dr. Peppard at the Department of Preventive Medicine, University of Wisconsin, 502 N. Walnut St., Madison, WI 53705, or at ppeppard{at}facstaff.wisc.edu.

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N Engl J Med 2000; 343:966-967, Sep 28, 2000. Correspondence

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