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    Sleep Apnea May Increase Risk for Hypertension

    The stereotype of a snorer is fairly accurate: an overweight, middle-aged man. But you can add another invisible feature to that image: high blood pressure. A new study suggests that people with sleep apnea, which is a temporary cessation in breathing that can cause snoring, are 45 percent more likely to have hypertension than are men and women with normal blood pressure. About 12 million Americans suffer from sleep apnea.

    Dr. F. Javier Nieto of the Johns Hopkins School of Hygiene and Public Health in Baltimore, Md., and colleagues, in the April 12, 2000, Journal of the American Medical Association, reported that the worse the apnea, the more likely a person will have hypertension, regardless of his or her age, sex, race, weight, or smoking and drinking habits. The researchers defined hypertension as a resting blood pressure of at least 140/90 mm Hg. And the results of their Sleep Heart Health Study were discussed on May 10 at the 96th International Conference of the American Thoracic Society meeting in Toronto, Canada.

    As part of the community-based multicenter Sleep Heart Health Study, the researchers examined 6,132 men and women over age 40. While the participants were sleeping, the
    team recorded their eye movements, muscle activities, heart rates, airflow, blood oxygen levels and the electrical activity in their brains. They also asked the participants about their sleep habits, sleepiness, snoring and their knowledge of sleep apnea and its treatment.

    "This is the first study large enough to examine the relationship between sleep apnea and hypertension, independent of other cardiovascular risk factors," stated Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute (NHLBI), in an NHLBI press release.

    More than 40 percent of the participants who had the fewest episodes of apnea or hypopnea, which is unusually slow, shallow breathing, had hypertension. And 67 percent of the group with the most episodes (30 or more per hour) had it.

    Sleep apnea has been linked to hypertension in previous studies, but most of these studies had few participants and didn't carefully assess the participants' breathing, said the researchers. While this new study doesn't show that apnea causes high blood pressure, other studies suggest the link is causal. For example, when sleep apnea is successfully treated, the hypertension goes away even if the treatment doesn't normally lower blood pressure, they report.

    The researchers suspect that apnea causes hypertension by over-stimulating the sympathetic nervous system, which is responsible for the body's response to fear or surprise, said Dr. Nieto. Oxygen levels fall during apnea, carbon dioxide levels increase and the brain signals the body to take a deep breath. He noted that this is stressful when it happens many times an hour. And most people with apnea experience up to 20 to 30 episodes, which last about 10-seconds each, per hour.

    Not all people with hypertension should get checked for sleep apnea, he said. However, if someone is a heavy snorer and doesn't feel rested in the morning, they should ask their doctor about apnea. And this is especially true if they are overweight and have hypertension.


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