Prolonged short sleep duration and poor sleep quality may lead to the onset and/or maintenance of arterial hypertension. Patients with obstructive sleep apnoea (OSA) and high blood pressure (BP), compared with hypertensive subjects without OSA, show increased prevalence of left ventricular hypertrophy (LVH) and increased urinary albumin excretion (UAE). Nevertheless, data linking other common sleep disorders, such as insomnia and restless legs syndrome (RLS) and the onset of hypertensive-related organ damage (OD) are lacking. The aim of the present study was to assess the association of OSA, insomnia, and RLS with cardiac and renal OD in a cohort of adults with hypertension.
In a prospective-observational study, we enrolled 160 consecutive patients aged between 18 and 60 years old, who underwent full assessment for OD by means of transthoracic echocardiography, UAE, and estimated glomerular filtration rate measurement. All patients were also screened to evaluate the risk of insomnia with the Insomnia Severity Index (ISI), OSA with the STOP-Bang, and RLS using the RLS Rating Score.
99 males and 61 females, with median age 47 (11) years, body mass index 25.5 (5.8) kg/m2, office systolic BP 144 (24) mmHg and diastolic BP 92 (12) mmHg, have been studied.
In the group with high risk of OSA (STOP-Bang score > or = 4) we observed an increased left ventricular mass index (LVMI) [119 (35) vs. 104 (26) g/m2, p = 0.002] and diastolic dysfunction parameters [left atrium volume index 27.5 (6.0) vs 24.0 (5.0) ml/m2, p = 0.005; mitral E/A ratio 1.1 (0.2) vs 1.0 (1.8), p = 0.01]. At multivariate analysis office systolic BP values and STOP-Bang score were independent predictors of LVMI (β = 0.18, p = 0.023 and β = 0.23, p = 0.003, respectively). No association with cardiac OD was seen in patients at increased risk of insomnia and RLS. No correlation was observed with renal OD for all subgroups.
The STOP-Bang, a simple, validated, and reproducible questionnaire, which predicts a high risk of OSA, is associated with hypertension-related heart remodelling in a cohort of hypertensive subjects and might be used to predict patients at risk of developing cardiac OD.
1Hypertension Unit - DIMED, Department of Internal Medicine, University of Padua, Italy, Padua, Italy
2Hypertension Unit, Ospedale S. Bortolo, University of Padua, Italy, Vicenza, Italy
3Unit of Secondary Arterial Hypertension, Department of Internal Medicine, Sapienza University of Rome, Italy, Rome, Italy