Relationship Between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Drug-Resistant Hypertension

Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether t...

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Bibliographic Details
Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2010-12, Vol.56 (6), p.1077-1082
Main Authors: Friedman, Oded, Bradley, T. Douglas, Chan, Christopher T, Parkes, Robert, Logan, Alexander G
Format: Article
Language:English
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Clinical manifestations. Epidemiology. Investigative techniques. Etiology
Cohort Studies
Diuretics - therapeutic use
Drug Resistance
Female
Fluid Shifts
Humans
Hypertension - complications
Hypertension - drug therapy
Hypertension - physiopathology
Male
Medical sciences
Middle Aged
Severity of Illness Index
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - drug therapy
Sleep Apnea, Obstructive - physiopathology
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Summary:Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether the spontaneous overnight fluid shift from the legs to the upper body is associated with obstructive sleep apnea in hypertensive subjects and whether its magnitude is greater in drug-resistant hypertension. Leg fluid volume and the circumference of the calf and neck were measured before and after sleep in drug-resistant hypertensive (n=25) and controlled hypertensive (n=15) subjects undergoing overnight polysomnography. The severity of obstructive sleep apnea was greater in the drug-resistant hypertensive group than in the controlled hypertensive group (apnea-hypopnea index43.0±5.4 versus 18.1±4.2 events per hour of sleep; P=0.02, case-mix adjusted). In both groups, the apnea-hypopnea index strongly related to the amount of leg fluid volume displaced (R=0.56; P
ISSN:0194-911X
1524-4563
DOI:10.1161/HYPERTENSIONAHA.110.154427