High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

Wei-Nung Liu; Ko-Huan Lin; Kun-Zhe Tsai; Chen-Chih Chu; Yun-Chen Chang; Younghoon Kwon; Gen-Min Lin

doi:10.12998/wjcc.v11.i30.7309

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

World J Clin Cases. 2023 Oct 26;11(30):7309-7317. doi: 10.12998/wjcc.v11.i30.7309.

Authors

Wei-Nung Liu¹, Ko-Huan Lin², Kun-Zhe Tsai³, Chen-Chih Chu¹, Yun-Chen Chang⁴, Younghoon Kwon⁵, Gen-Min Lin^{1

6}

Affiliations

¹ Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
² Department of Psychiatry, Hualien Tzu Chi Hospital, Hualien City 970, Taiwan.
³ Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei 104, Taiwan.
⁴ School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung 406, Taiwan.
⁵ Department of Medicine, University of Washington, Seattle, 98104-2499, United States.
⁶ Department of Medicine, Hualien Armed Forces General Hospital, Hualien City 970, Taiwan. farmer507@yahoo.com.tw.

Abstract

Background: Epidemiological studies have revealed an association between obstructive sleep apnea (OSA) and hypertension in the general population, while the association in military personnel was rarely investigated.

Aim: To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.

Methods: A total of 746 military personnel, aged 27.9 years, were included in the cardiorespiratory fitness and health in armed forces (CHIEF)-sleep study in Taiwan in 2020. Antihypertensive medications were not used by the subjects. High risk for OSA was assessed using the Berlin Questionnaire. Hypertension was defined using the 7^th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. The cutoff levels of systolic and diastolic blood pressure (SBP and DBP) for the 2017 ACC/AHA- and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg, respectively. Hypertension phenotypes included isolated systolic and diastolic hypertension (ISH, high SBP only and IDH, high DBP only) and combined hypertension (both high SBP and DBP). Multivariable logistic regression analysis with adjustment for demographics, lifestyle and metabolic biomarkers.

Results: The prevalence of high risk for OSA, JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%, 5.2% and 22.0%, respectively. Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension (odds ratios (ORs) and 95% confidence intervals: 2.82 (1.07-7.42) and 7.54 (1.10-51.54), although the probabilities of ISH and IDH were unaffected by a high risk for OSA (ORs: 1.96 and 2.35, respectively, both P > 0.05). In contrast, no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.

Conclusion: A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

Keywords: Asian young adults; Berlin questionnaire; Hypertension phenotypes; Military; Sleep apnea.