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High prevalence of unrecognized sleep apnoea in drug-resistant hypertension

Logan, Alexander G.a,c; Perlikowski, Sandra M.a; Mente, Andrewa; Tisler, Andrasa; Tkacova, Ruzenab; Niroumand, Mitrab; Leung, Richard S. T.b; Bradley, T. Douglasb,c

Original papers: Clinical aspects

Objectives  To determine the prevalence of obstructive sleep apnoea (OSA) in adult patients with drug-resistant hypertension, a common problem in a tertiary care facility.

Design  Cross-sectional study.

Setting  University hypertension clinic.

Patients and methods  Adults with drug-resistant hypertension, defined as a clinic blood pressure of 140/90 mmHg, while taking a sensible combination of three or more antihypertensive drugs, titrated to maximally recommended doses. Each of the 41 participants completed an overnight polysomnographic study and all but two had a 24 h ambulatory blood pressure measurement.

Results  Prevalence of OSA, defined as an apnoea-hypopnoea index of 10 obstructive events per hour of sleep, was 83% in the 24 men and 17 women studied. Patients were generally late middle-aged (57.2 ± 1.6 years, mean ± SE), predominantly white (85%), obese (body mass index, 34.0 ± 0.9 kg/m2) and taking a mean of 3.6 ± 0.1 different antihypertensive medications daily. OSA was more prevalent in men than in women (96 versus 65%, P = 0.014) and more severe (mean apnoea–hypopnoea index of 32.2 ± 4.5 versus 14.0 ± 3.1 events/h, P = 0.004). There was no gender difference in body mass index or age. Women with OSA were significantly older and had a higher systolic blood pressure, lower diastolic blood pressure, wider pulse pressure and slower heart rate than women without OSA.

Conclusions  The extraordinarily high prevalence of OSA in these patients supports its potential role in the pathogenesis of drug-resistant hypertension, and justifies the undertaking of a randomized controlled trial to corroborate this hypothesis.

aSamuel Lunenfeld Research Institute, Mount Sinai Hospital, bSleep Research Laboratory of the Toronto Rehabilitation Institute and cDepartment of Medicine of the University Health Network and University of Toronto, Toronto, Ontario, Canada.

Sponsorship: This work was supported by a grant-in-aid from the Heart & Stroke Foundation of Ontario (NA4099). Personal support awards were received from the International Society of Nephrology for A.T., from Canadian Institutes of Health Research for A.M. and R.S.T.L., and from Respironics Inc for R.T.T.D.B. holds a Senior Scientist Award from the Canadian Institutes of Health Research.

Correspondence and requests for reprints to Alexander G. Logan, Mount Sinai Hospital, Suite 435, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. Tel: +1 416 586 5187; fax: +1 416 586 8434; e-mail:

Received 23 October 2000

Revised 17 July 2001

Accepted 3 August 2001

© 2001 Lippincott Williams & Wilkins, Inc.