Association of Sleep Apnea Severity with Resistant Hypertension and Cardiovascular Morbidity in Obese Adults
DOI:
https://doi.org/10.53350/Annalspakmed.1.9.4Keywords:
Obstructive Sleep Apnea, Resistant Hypertension, Cardiovascular Morbidity, Obesity, Apnea–Hypopnea Index, Left Ventricular Hypertrophy, Coronary Artery Disease.Abstract
Background: Obstructive Sleep Apnea (OSA) is slowly being considered as a leading cause of cardiometabolic illnesses especially in obese adults. Nocturnal intermittent hypoxia, sympathetic hyperactivity, and endothelial dysfunction related to OSA could make people susceptible to resistant hypertension and cardiovascular morbidity. Nevertheless, the power of this relationship among obese individuals in Pakistan has not been studied sufficiently.
Aim: To investigate the association between OSA severity and resistant hypertension and cardiovascular morbidity prevalence among obese adults who were admitted to tertiary care hospitals in Punjab, Pakistan.
Methods: It is a cross-sectional study involving 120 obese adults (BMI 30 kg/m 2 or higher) who will be recruited between January 2024 and May 2025. Every subject was subjected to overnight polysomnography to categorize OSA into mild, moderate and severe according to Apnea Hypopnea Index (AHI). Standard clinical protocol was used to measure blood pressure and resistant hypertension was considered to be a BP of 140/90 mmHg or higher even under the influence of 3 or more antihypertensive drugs with or without a diuretic. The clinical records, ECG and echocardiography were used to evaluate cardiovascular morbidity (left ventricular hypertrophy (LVH), coronary artery disease (CAD), stroke, and heart failure). Chi-square tests and multivariate logistic regression were used in statistical analysis.
Findings: OSA severity was significantly dose-dependent with resistant hypertension which rose with moderate OSA (20 per cent) to severe hypertension (43.3 per cent) (p < 0.001). The cardiovascular morbidity in severe OSA was remarkably high, and LVH (50%), CAD (30%), and stroke/TIA (13.3%) exhibited a definite upward trend. The severe OSA was still a predictor of resistant hypertension even after the confounders were adjusted.
Conclusion: Hospitalization of obese adults with resistant hypertension and cardiovascular morbidity is highly related to the severity of OSA. OSA can be early diagnosed and treated to significantly lower cardiovascular risk among high-risk groups.
References
1. Morrow D, Fleming S, O’Gorman C. Obstructive sleep apnea and cardiovascular disease: mechanisms and clinical implications. Clin Med. 2019;19:441-445. doi:10.7861/clinmedicine.19-6-441.
2. Parati G, Lombardi C, Hedner J. Sleep apnea and hypertension: pathophysiologic mechanisms and clinical management. Hypertension. 2020;75:663-671. doi:10.1161/HYPERTENSIONAHA.119.14241.
3. Pedrosa RP, Almeida DP, Drager LF. Obstructive sleep apnea and resistant hypertension: a contemporary review. Curr Hypertens Rep. 2020;22:34. doi:10.1007/s11906-020-01035-0.
4. Sanchez-de-la-Torre M, Turnbull F, Barbé F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med. 2020;8:613-622. doi:10.1016/S2213-2600(20)30030-8.
5. Nagayoshi M, Yamada M, Kawano H. Severity of obstructive sleep apnea and left ventricular hypertrophy in obese adults. Sleep Med. 2021;82:166-173. doi:10.1016/j.sleep.2021.03.045.
6. Luo J, Zhang X, Li Y. Association between sleep apnea and resistant hypertension: a meta-analysis. J Clin Hypertens. 2021;23:1021-1029. doi:10.1111/jch.14224.
7. Cunha TM, Ferreira CL, Lino F. Obesity and sleep apnea as synergistic predictors of cardiovascular disease. Nutrients. 2021;13:3565. doi:10.3390/nu13103565.
8. Kim J, Choi H, Lee S. Impact of sleep apnea on hypertension control in obese populations. J Am Heart Assoc. 2021;10:e020808. doi:10.1161/JAHA.121.020808.
9. Mahmud A, Iqbal M, Khan S. Burden of obstructive sleep apnea among hypertensive adults in South Asia. Sleep Breath. 2022;26:917-925. doi:10.1007/s11325-021-02392-w.
10. Alves M, Lourenço R, Fernandes M. Sleep-disordered breathing and cardiac remodeling in obese patients. Obes Rev. 2022;23:e13407. doi:10.1111/obr.13407.
11. Prakash S, Gupta S, Shah N. Resistant hypertension in patients with severe sleep apnea: clinical predictors and outcomes. Clin Hypertens. 2022;28:12. doi:10.1186/s40885-022-00205-7.
12. Zheng Y, Song G, Wang W. Obstructive sleep apnea and risk of stroke in obese adults. Neurology. 2022;99:e1252-e1260. doi:10.1212/WNL.0000000000200853.
13. Taylor JA, Melville C, Jordan AS. Pathophysiologic pathways linking obstructive sleep apnea and cardiovascular disease. Chest. 2023;163:890-902. doi:10.1016/j.chest.2022.10.039.
14. Islam Z, Rashid A, Waqar M. Prevalence of sleep apnea and its cardiovascular consequences in Pakistani adults with obesity. Pak J Med Sci. 2023;39:512-518. doi:10.12669/pjms.39.2.6168.
15. Martinez F, Gonzalez R, Bailey T. Association of apnea severity with uncontrolled blood pressure. Sleep Health. 2023;9:281-289. doi:10.1016/j.sleh.2023.01.006.
16. Das N, Kumar A, Shah R. Obstructive sleep apnea as a predictor of cardiac dysfunction in high-risk adults. Heart Lung. 2023;58:134-142. doi:10.1016/j.hrtlng.2023.02.012.
17. Fang L, Zhang Z, Liu X. Sleep apnea severity and cardiovascular outcomes: insights from a multicenter cohort. Sleep Med Rev. 2024;72:101789. doi:10.1016/j.smrv.2023.101789.
18. Khalid H, Siddique A, Raza M. Resistant hypertension and sleep apnea in obese Pakistani adults: a clinical correlation study. J Coll Physicians Surg Pak. 2024;34:12-18. doi:10.29271/jcpsp.2024.01.12.
19. Miranda M, Vale J, Santos R. Obesity, sleep apnea, and cardiometabolic risk: emerging perspectives. Eur J Clin Invest. 2024;54:e14107. doi:10.1111/eci.14107.
20. Pote N, Huang C, Naderi N. Sleep apnea as an independent driver of resistant hypertension: updated evidence. Curr Cardiol Rep. 2025;27:118-129. doi:10.1007/s11886-025-01956-2.
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