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Cited by 81Obstructive Sleep Apnea ResearchBlood Pressure and Hypertension StudiesSleep and related disorders

Association Between Sleep Apnea and Blood Pressure Control Among Blacks: Jackson Heart Sleep Study

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Johnson, Dayna A., Thomas, S. Justin, Abdalla, Marwah, Guo, Na, Yano, Yuichiro, Rueschman, Michael, Tanner, Rikki M., Mittleman, Murray A. +4 more·2019·Circulation
DOI 10.1161/circulationaha.118.036675PMC PMC6428682
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Abstract

Background: Blacks have a high prevalence of hypertension and uncontrolled blood pressure (BP), each of which may be partially explained by untreated sleep apnea. We investigated the association of sleep apnea with uncontrolled BP and resistant hypertension in blacks. Methods: Between 2012 and 2016, Jackson Heart Sleep Study participants (N=913) underwent an in-home Type 3 sleep apnea study, clinic BP measurements, and anthropometry. Moderate or severe obstructive sleep apnea (OSA) was defined as a respiratory event index ≥15, and nocturnal hypoxemia was quantified as percent sleep time with <90% oxyhemoglobin saturation. Prevalent hypertension was defined as either a systolic BP ≥130 mm Hg or diastolic BP > 80mm Hg, use of antihypertensive medication, or self-report of a diagnosis of hypertension. Controlled BP was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg; uncontrolled BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with use of 1 to 2 classes of antihypertensive medication; and resistant BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with the use of ≥3 classes of antihypertensive medication (including a diuretic) or use of ≥4 classes of antihypertensive medication regardless of BP level. Multinomial logistic regression models were fit to determine the association between OSA severity and uncontrolled BP or resistant hypertension (versus controlled BP) after multivariable adjustment. Results: The analytic sample with hypertension (N=664) had a mean age of 64.0 (SD,10.6) years, and were predominately female (69.1%), obese (58.6%), and college educated (51.3%). Among the sample, 25.7% had OSA, which was untreated in 94% of participants. Overall, 48% of participants had uncontrolled hypertension and 14% had resistant hypertension. After adjustment for confounders, participants with moderate or severe OSA had a 2.0 times higher odds of resistant hypertension (95% confidence interval [CI], 1.14–3.67). Each standard deviation higher than <90% oxyhemoglobin saturation was associated with an adjusted odds ratio for resistant hypertension of 1.25 (95% CI 1.01–1.55). OSA and <90% oxyhemoglobin saturation were not associated with uncontrolled BP. Conclusion: Untreated moderate or severe OSA is associated with increased odds of resistant hypertension. These results suggest that untreated OSA may contribute to inadequate BP control in blacks.

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  • A recent study demonstrated a two-fold increase in risk of resistant hypertension in African-Americans with severe OSA, and the burden of undiagnosed OSA is high in this population.

    “A recent study demonstrated a two-fold increase in risk of resistant HTN in African-Americans with severe OSA, and it is notable that the burden of undiagnosed OSA is high in this population.702”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [702]

    The Abstract Results report approximately twofold higher *odds* of resistant hypertension for participants with moderate or severe OSA, and the Discussion states that OSA was largely undiagnosed. For severe OSA alone, however, the Results report adjusted odds of 3.58 relative to no OSA, not a twofold increase; the study reports odds rather than risk. (LLM, conf=0.91)

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  • Undiagnosed cases of obstructive sleep apnea are particularly prevalent in Black patients.

    “Undiagnosed cases are particularly prevalent in Black patients.11”

    From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [11]

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Research works printed but not linked: 1

  1. [17]National Institutes of Health. The database of Genotypes and Pheno-types (dbGaP). https://www.ncbi.nlm.nih.gov/gap/. 2018 Accessed November 8, 2018.

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Authors
Johnson, D. A., Thomas, S. J., Abdalla, M., Guo, N., Yano, Y., Rueschman, M., Tanner, R. M., Mittleman, M. A., Calhoun, D. A., Wilson, J. G., Muntner, P., & Redline, S.
Affiliations
  • Brigham and Women's Hospital (US)
  • University of Alabama at Birmingham (US)
  • Columbia University (US)
  • Duke University (US)
  • Beth Israel Deaconess Medical Center (US)
  • University of Mississippi Medical Center (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-03-05
Volume
139
Issue
10
Pages
1275-1284
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.118.036675
PMC
PMC6428682
OpenAlex
W2919906321
Semantic Scholar
40caa0d5feb851c138b2045d0a4016b37db30c49
Cited by
81
References
56
Citations by year
2026: 5 · 2025: 12 · 2024: 8 · 2023: 6 · 2022: 19 · 2021: 12 · 2020: 9 · 2019: 10
FWCI
8.57
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (KL2TR001874)
  • National Heart, Lung, and Blood Institute (HHSN268201800012C, HHSN268201800010 I, HHSN268201800014 I, R01HL110068, R35HL135818, HHSN268201800012 I, K01HL138211, HHSN268201800014C, HHSN268201800015I, R01HL117323, HHSN268201800011C, HHSN268201800011I, T32HL007901)
  • National Institute of General Medical Sciences (U54GM115428)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
  • National Center for Advancing Translational Sciences
  • National Institute on Minority Health and Health Disparities (L60 MD013236, HHSN268201800013I)
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
obstructive sleep apnea, resistant hypertension, uncontrolled hypertension, hypertension, Black people, nocturnal hypoxemia, hemoglobin oxygen saturation, untreated sleep apnea, Jackson Heart Study, antihypertensive drugs, sleep apnea severity, cardiovascular risk, Jackson, Mississippi, Jackson, Tennessee
MeSH terms
Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Black or African American, Blood Pressure, Cross-Sectional Studies, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged, Mississippi, Risk Factors, Severity of Illness Index, Sleep, Sleep Apnea Syndromes, Prevalence, Young Adult

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