Association between obstructive sleep apnea and resistant hypertension: systematic review and meta-analysis

Abass Mahamoud Ahmed; Salman Mohamud Nur; Yuan Xiaochen

doi:10.3389/fmed.2023.1200952

Association between obstructive sleep apnea and resistant hypertension: systematic review and meta-analysis

Front Med (Lausanne). 2023 Jun 2:10:1200952. doi: 10.3389/fmed.2023.1200952. eCollection 2023.

Authors

Abass Mahamoud Ahmed^{1

2}, Salman Mohamud Nur^{2

3}, Yuan Xiaochen^{1

2}

Affiliations

¹ Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
² Medical College, Yangzhou University, Yangzhou, Jiangsu, China.
³ Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China.

Abstract

Introduction: Obstructive sleep apnea syndrome (OSAS) is a chronic disorder characterized by recurring episode obstruction and collapse of upper airways during sleep, leading to hypoxia and sleep disruption. OSAS is commonly associated with an increased prevalence of hypertension. The underlying mechanism in OSA with hypertension is related to intermittent hypoxia. This hypoxia induces endothelial dysfunction, overactivity of sympathetic effects, oxidative stress, and systemic inflammation. Hypoxemia triggers the sympathetic process's overactivity, leading to the development of resistant hypertension in OSA. Thus, we hypothesize to evaluate the association between resistant hypertension and OSA.

Methods: The PubMed, ClinicalTrails.gov, CINAHL, Google Scholar, Cochrane Library, and Science Direct databases were searched from 2000 to January 2022 for studies demonstrating the association between resistant hypertension and OSA. The eligible articles underwent quality appraisal, meta-analysis, and heterogeneity assessment.

Results: This study comprises seven studies, including 2,541 patients ranged from 20 to 70 years. The pooled analysis of six studies demonstrated that OSAS patients with a history of increased age, gender, obesity, and smoking status are at an increased risk for resistant hypertension (OR: 4.16 [3.07, 5.64], I²:0%) than the non-OSAS patients. Similarly, the pooled effect demonstrated that patients with OSAS were at an increased risk of resistant hypertension (OR: 3.34 [2.44, 4.58]; I²:0%) than the non-OSAS patients when all associated risk factors were adjusted using multivariate analysis.

Conclusion: This study concludes that OSAS patients with or without related risk factors demonstrated increased risk for resistant hypertension.

Keywords: apnea-hypoxia index (AHI); hypoxia; obstructive sleep apnoea (OSA); resistant hypertension; risk factors.

Publication types

Systematic Review

Grants and funding

This study was supported by Jiangsu Provincial Health and Family Planning Commission Guidance Project (Z2017020) and Jiangsu Provincial Department of Science and Technology Social Development Key R&D Program (BE2015663).