Age-Dependent Associations Between Sleep-Disordered Breathing and Hypertension: Importance of Discriminating Between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study
Abstract
Background— Sleep-disordered breathing (SDB) is associated with hypertension in the middle-aged. The association is less clear in older persons. Most middle-aged hypertensives have systolic/diastolic hypertension, whereas isolated systolic hypertension (ISH) is common among persons over 60 years. Mechanistically, only systolic/diastolic hypertension is expected to be associated with SDB, but few studies of SDB and hypertension distinguish systolic/diastolic hypertension from ISH. Prior investigations may have underestimated an association between SDB and systolic/diastolic hypertension in the elderly by categorizing individuals with ISH as simply hypertensive. Methods and Results— We conducted cross-sectional analyses of 6120 participants in the Sleep Heart Health Study, stratified by age: 40 to 59 (n=2477) and ≥60 years. Outcome measures included apnea-hypopnea index (AHI; average number of apneas plus hypopneas per hour of sleep), systolic/diastolic hypertension (≥140 and ≥90 mm Hg), and ISH (≥140 and <90 mm Hg). With adjustment for covariates, ISH was not associated with SDB in either age category. In those aged<60 years, AHI was significantly associated with higher odds of systolic/diastolic hypertension (AHI 15 to 29.9, OR=2.38 [95% CI 1.30 to 4.38]; AHI ≥30, OR=2.24 [95% CI 1.10 to 4.54]). Among those aged ≥60 years, no adjusted association between AHI and systolic/diastolic hypertension was found. Conclusions— SDB is associated with systolic/diastolic hypertension in those aged <60 years. No association was found between SDB and systolic/diastolic hypertension in those aged ≥60 years or between SDB and ISH in either age category. These findings have implications for SDB screening and treatment. Distinguishing between hypertensive subtypes reveals a stronger association between SDB and hypertension for those aged <60 years than previously reported.
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Obstructive sleep apnea is a highly prevalent syndrome associated with substantial morbidity and increased mortality.
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
From Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine (2006) · cites this paper as [8]
The Discussion (page not available) says sleep-disordered breathing is common in the general population and reports an association with hypertension in adults aged 40–59, supporting prevalence and a specific form of morbidity. It does not establish increased mortality or a general association with substantial morbidity; its hypertension finding is age-dependent. (LLM, conf=0.86)
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- Authors
- Haas, D. C., Foster, G. L., Nieto, F. J., Redline, S., Resnick, H. E., Robbins, J. A., Young, T., & Pickering, T. G.
- Affiliations
- University of Wisconsin System (US)
- ORCID
- Venue
- Circulation
- Published
- 2005-02-08
- Volume
- 111
- Issue
- 5
- Pages
- 614-621
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2747636168
- Cited by
- 343
- References
- 34
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 11 · 2023: 11 · 2022: 10 · 2021: 12 · 2020: 12 · 2019: 10 · 2018: 19 · 2017: 20 · 2016: 14 · 2015: 26 · 2014: 18 · 2013: 20 · 2012: 20
- FWCI
- 12.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Minnesota (U01HL64360, U01HL53941, U01HL53940, U01HL539 31, U01HL53938, U01HL53934, U01HL53937, U01HL63463, U01HL53916)
- University of Washington (U01HL53941, U01HL53938, U01HL53940, U01HL63463, U01HL53916, U01HL53931, U01HL53934)
- Johns Hopkins University (U01-HL53938, U01HL53937, U01HL53916, U01HL63463, U01HL53941, U01HL64360, U01HL53931, U01HL53940, U01HL53934)
- Case Western Reserve University (U01HL63463, U01HL53934, U01HL53931, U01HL53916, U01HL63429, U01HL53938, U01HL53940, U01HL53941)
- Strong
- York University
- National Institutes of Health (5u01hl053940-05, 5u01hl053934-14)
- University of California, Davis (U01HL53941, U01HL53931, U01HL53940, U01HL53938, U01HL53916, U01HL63463, U01HL53934)
- National Heart, Lung, and Blood Institute (U01 HL 53940, U01HL53938, U01HL053941, U01HL053938, U01 HL53934, U01HL053937, U01 HL 53941, U01 HL53916, U01HL053931, U01 HL 63429, U01HL064360, U01HL053916, U01 HL53931, U01HL063463, U01HL64360, U01HL063429, U01HL63463, U01-HL53937)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep-disordered breathing, hypertension, isolated systolic hypertension, systolic-diastolic hypertension, apnea-hypopnea index, age differences, older adults, middle-aged adults, Sleep Heart Health Study
- MeSH terms
- Adult, Age Factors, Aged, Antihypertensive Agents, Cross-Sectional Studies, Diastole, Female, Humans, Hypertension, Male, Middle Aged, Risk Factors, Sleep Apnea Syndromes, Systole, Sleep Apnea, Central
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