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Draelants L, Point C, Wacquier B, Lanquart JP, Loas G, Hein M. 10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects. Life (Basel) 2023; 13:1379. [PMID: 37374161 PMCID: PMC10303626 DOI: 10.3390/life13061379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. Framingham Risk Score ≥ 10% was used as a cut-off to identify hypertensive subjects with high 10-year risk for CVD. The association between 10-year risk for CVD and COMISA was investigated using logistic regression analyses. 65.3% of hypertensive subjects from our sample presented a high 10-year risk for CVD. After controlling for major confounding factors, multivariate logistic regression analyses demonstrated that unlike its components present separately, COMISA was significantly associated with high 10-year risk for CVD in hypertensive subjects (OR 1.88, 95% CI 1.01-3.51). In this study, we have demonstrated that the negative synergy between obstructive sleep apnea syndrome and insomnia disorder seems to play a central role in the 10-year risk for CVD in hypertensive subjects, which seems to indicate that the establishment of a systematic research and an adapted treatment of COMISA could open new perspectives to promote a better cardiovascular outcome in this specific subgroup of patients.
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Affiliation(s)
| | | | | | | | | | - Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (L.D.); (C.P.); (B.W.); (J.-P.L.); (G.L.)
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Zota IM, Roca M, Leon MM, Cozma CD, Anghel L, Statescu C, Sascau R, Hancianu M, Mircea C, Ciocoiu M, Cumpat CM, Mitu F. Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension-A Pilot Prospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13081447. [PMID: 37189548 DOI: 10.3390/diagnostics13081447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.
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Affiliation(s)
- Ioana Madalina Zota
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Maria Magdalena Leon
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Corina Dima Cozma
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Larisa Anghel
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Radu Sascau
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Monica Hancianu
- Department of Pharmacognosy, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Cornelia Mircea
- Department of Pharmaceutical Sciences (II), Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Morpho-Functional Sciences (Pathophysiology), Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Carmen Marinela Cumpat
- Department of Medical Specialties (III), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study. Sleep Med 2023; 104:113-120. [PMID: 36930993 DOI: 10.1016/j.sleep.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index ≥15 events/hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4-itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 ± 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15-2.82), lower monthly income (OR: 1.74; 95% IC:1.01-3.0) and EDS (OR: 1.63; 95% IC:1.05-2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.
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Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
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Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
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Rana D, Torrilus C, Ahmad W, Okam NA, Fatima T, Jahan N. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus 2020; 12:e10424. [PMID: 32953361 PMCID: PMC7494423 DOI: 10.7759/cureus.10424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/13/2020] [Indexed: 12/25/2022] Open
Abstract
In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. OSA can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.
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Affiliation(s)
- Dibyata Rana
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chenet Torrilus
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wiqas Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nkechi A Okam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tehreem Fatima
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Affiliation(s)
- Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Vicente-Herrero M, Capdevila-García L, Bellido-Cambrón M, Ramírez-Iñiguez de la Torre M, Lladosa-Marco S. Presión arterial y síndrome de apnea-hipopnea del sueño en trabajadores. Test STOP-Bang frente a la escala de Epworth. HIPERTENSION Y RIESGO VASCULAR 2018; 35:15-23. [DOI: 10.1016/j.hipert.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/11/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
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Righi CG, Martinez D, Gonçalves SC, Gus M, Moreira LB, Fuchs SC, Fuchs FD. Response to the letter entitled “Obstructive sleep apnea, excessive daytime sleepiness, and adherence to antihypertensive treatment: Questionnaire survey”. J Clin Hypertens (Greenwich) 2017; 19:1384. [DOI: 10.1111/jch.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Camila Gosenheimer Righi
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Denis Martinez
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
- Division of Cardiology; Hypertension and Sleep Clinics; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Sandro Cadaval Gonçalves
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
- Division of Cardiology; Hypertension and Sleep Clinics; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Miguel Gus
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
- Division of Cardiology; Hypertension and Sleep Clinics; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Leila Beltrami Moreira
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
- Division of Cardiology; Hypertension and Sleep Clinics; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Sandra C. Fuchs
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
| | - Flavio Danni Fuchs
- Graduate Studies Program in Cardiology; School of Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
- Division of Cardiology; Hypertension and Sleep Clinics; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul; Porto Alegre RS Brazil
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Kawada T. Obstructive sleep apnea, excessive daytime sleepiness, and adherence to antihypertensive treatment: Questionnaire survey. J Clin Hypertens (Greenwich) 2017; 19:1383. [DOI: 10.1111/jch.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health; Nippon Medical School; Bunkyo-Ku Tokyo Japan
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Grant AB, Williams NJ, Pandi-Perumal SR. Nonadherence to antihypertensive medications in adults with high risk for obstructive sleep apnea. J Clin Hypertens (Greenwich) 2017; 19:540-542. [PMID: 28345218 DOI: 10.1111/jch.12990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Barnes Grant
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Natasha J Williams
- Division of Health and Behavior, Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
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