Association of Obstructive Sleep Apnea With Urinary Albumin Excretion in Essential Hypertension: A Cross-sectional Study
| Autor: | Kyriakos Dimitriadis, Ioannis Kallikazaros, Costas Tsioufis, Dimitris Petras, Maria Selima, Anastasia Amfilochiou, Dimitris Tsiachris, Christodoulos Stefanadis, Costas Thomopoulos |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Ambulatory blood pressure Polysomnography Blood Pressure Essential hypertension Severity of Illness Index Risk Factors Internal medicine Albuminuria Humans Medicine Retrospective Studies Sleep Apnea Obstructive business.industry Incidence Sleep apnea Blood Pressure Monitoring Ambulatory Middle Aged Prognosis medicine.disease United States nervous system diseases respiratory tract diseases Obstructive sleep apnea Cross-Sectional Studies Endocrinology Blood pressure Apnea–hypopnea index Nephrology Hypertension Electrocardiography Ambulatory Cardiology Female Microalbuminuria medicine.symptom business |
| Zdroj: | American Journal of Kidney Diseases. 52:285-293 |
| ISSN: | 0272-6386 |
| DOI: | 10.1053/j.ajkd.2008.05.001 |
| Popis: | Microalbuminuria reflects a state of widespread vascular dysfunction, whereas obstructive sleep apnea (OSA) further promotes atherosclerotic damage in hypertension.Cross-sectional.In an outpatient hypertensive unit, 62 untreated hypertensive patients (aged 48 +/- 7 years; office blood pressure [BP], 151 +/- 8/97 +/- 7 mm Hg) with OSA and 70 hypertensive patients without OSA (apnea hypopnea index [AHI]or = 5) matched for age, sex, smoking status, body mass index, and 24-hour pulse pressure were studied.Hypertension and OSA compared with hypertension without OSA. OSA defined as AHI greater than 5, documented by polysomnography.Albuminuria assessed by urinary albumin-creatinine ratio (ACR).Participants underwent polysomnography, ambulatory BP monitoring, echocardiography, routine metabolic profile assessment, and glomerular filtration rate estimation, whereas ACR was measured from 2 nonconsecutive morning spot urine samples.Hypertensive patients with OSA compared with those without OSA showed increased 24-hour diastolic BP (87 +/- 7 versus 85 +/- 7 mm Hg; P = 0.03) and nighttime pulse pressure (50 +/- 10 versus 45 +/- 10 mm Hg; P = 0.008), but did not differ regarding metabolic profile and estimated glomerular filtration rate. Albuminuria was greater by 57% in patients with OSA compared with those without OSA: log(10)ACR, 1.1 +/- 0.2 versus 0.7 +/- 0.4 mg/g; P0.001). In the entire study population, log10(ACR) correlated with log10(AHI) (r = 0.35; P0.001), minimum oxygen saturation during sleep (r = -0.33; P0.001), 24-hour pulse pressure (r = 0.38; P0.001), and nighttime pulse pressure (r = 0.21; P =0 .01). In a multivariable linear regression model, independent predictors of ACR were AHI (beta = 0.36; P0.001) and 24-hour pulse pressure (beta = 0.25; P = 0.01).Cross-sectional study.Albuminuria increases within the normal range in hypertensive individuals with OSA compared with those without OSA proportionally to OSA severity independently of confounders. The association of upper-airway dysfunction with albuminuria and pulsatile hemodynamic load may provide an explanatory mechanism for the OSA-related risk in hypertension. |
| Databáze: | OpenAIRE |
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