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View in Article Scopus 54 PubMed Crossref Google Scholar. Several reviews 43 , 44 have been published about the diagnosis and physical examination of patients with OSA.

The common physical findings in OSA are listed in Table 3. The gold standard for an accurate diagnosis of OSA is a polysomnography evaluation performed in a sleep disorders unit.

During this overnight evaluation, the number of apneas and hypopneas can be quantified, their duration measured, their relationship to body position and sleep stages determined, the level of oxygen desaturation measured and the existence of arrhythmic episodes can be quantified. This information determines the severity of the disorder and helps determine the treatment choice.

Other tests often performed to objectively evaluate daytime sleepiness include the Multiple Sleep Latency Test and the Maintainence of Wakefulness Test.

Treatment of OSA includes nonsurgical and surgical approaches. Weight loss should always be strongly encouraged in patients with OSA who are obese about 70 percent of all patients who have OSA are obese. Weight loss can produce good results and even small reductions in weight can produce major improvements in OSA.

During sleep, room air is continuously applied by a small, quiet air compressor that delivers positive pressure through a nasal mask. The CPAP system acts as a physical pressure splint to prevent partial or complete collapse of the upper airway during sleep.

CPAP is the treatment of choice for patients with moderate to severe OSA, but it is also used to treat patients with mild OSA and those with loud and continuous snoring. While CPAP is an extremely effective form of therapy, there are two pitfalls in its use.

It is not a permanent cure; when patients stop treatment, OSA returns within a few days. Secondly, because patients may be reluctant to attempt CPAP or persist in using it, family physicians should encourage and closely follow patients because the beneficial effects on quality of life can be great.

These patients, in most cases, were found to have mild OSA. These results were not surprising because, when lying in the lateral position, patients have significantly fewer breathing abnormalities than when lying in the supine position. In some instances, a total absence of breathing disturbances was observed when patients were lying in the lateral position.

For these patients and those who had an AHI of 10 or less while lying in the lateral position, position therapy represented a valuable and effective therapy. Results from another study 50 showed that patients with OSA who were hypertensive and normotensive and who avoided sleeping in the supine position for one month by using the tennis ball technique, a simple and inexpensive behavioral method, had a significant reduction in hour blood pressure values and blood pressure variability.

In the tennis ball technique, a wide cloth belt with a pocket that a tennis ball is placed into is worn around the chest so that the pocket with the ball is positioned in the middle of the back. When the patient rolls onto his or her back, the pressure of the tennis ball causes the patient to roll onto their side again.

If these preliminary results are confirmed in larger studies, avoiding the supine position during sleep could become a new nonpharmacologic treatment for many hypertensive patients. Oral devices placed in the mouth at bedtime to keep the mandible and tongue in a forward position during sleep can prevent upper airway obstruction during sleep.

This therapy has been shown to be useful primarily in patients with simple snoring and in patients with mild to moderate OSA. A wide variety of surgical procedures are currently used to treat OSA and, of these, uvulopalatopharyngoplasty is the most common.

This procedure can be performed using conventional or laser techniques. Unfortunately, only about 40 to 60 percent of patients who have OSA show an improvement in symptoms following the procedure, and it is impossible to predict which patients will benefit from surgery and which will not.

Other surgical procedures include relief of nasal obstruction, tonsillectomy, adenoidectomy, mandibular-maxillary surgery, and, most recently, somnoplasty, in which radiofrequency energy is used to shrink part of the tongue and soft palate. Silverberg DS, Oksenberg A. Essential and secondary hypertension and sleep disordered breathing: a unifying hypothesis.

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The study, which appears in the April 12, , issue of Journal of the American Medical Association, found those who suffer from moderate to severe sleep apnea were at increased risk of having high blood pressure.

Sleep apnea, characterized by snoring and frequent pauses in breathing during sleep, is a relatively common condition, most notably in those who are overweight.

The study involved more than 6, adult men and women age 40 or older. The presence of sleep apnea was detected using polysomnography, which simultaneously records brain waves, heart waves, blood oxygen levels, and breathing rate while a person sleeps. A team of technicians visited each participant at home in the evening and measured blood pressure and weight, as well as other health parameters, and then connected the person to a sleep monitor.

The average number of breathing pauses per hour of sleep was used to measure the degree of sleep apnea. The results of the study showed that people with more than 30 pauses per hour of sleep were more than twice as likely to suffer from high blood pressure than those with no breathing pauses.

An increased risk of high blood pressure was found even at moderate levels of sleep apnea. Since sleep apnea is more common in overweight individuals--who are already at a higher risk of high blood pressure--additional statistical analyses were conducted to control for body weight and waist circumference.

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Precision medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment. J Am Coll Cardiol ; 66 : — Download references. Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

You can also search for this author in PubMed Google Scholar. Correspondence to Yingling Zhou. Reprints and permissions. Cai, A. Hypertension and obstructive sleep apnea. Hypertens Res 39 , — Download citation. Received : 08 October Revised : 05 December Accepted : 24 December Published : 18 February Issue Date : June Anyone you share the following link with will be able to read this content:.

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Download PDF. Subjects Hypertension Sleep disorders Therapeutics. Abstract Obstructive sleep apnea OSA is a major modifiable risk factor of hypertension and hypertensive patients with OSA are at increased risk for cardiovascular diseases.

Management of hypertensive crisis: British and Irish Hypertension Society Position document Article Open access 22 November Pulmonary hypertension Article 04 January The global epidemiology of hypertension Article 05 February Introduction It is now well known that obstructive sleep apnea OSA is one of the common secondary causes of blood pressure BP elevation.

Definition, diagnosis and risk factors of OSA OSA occurs during nocturnal sleep and the diagnosis of OSA requires polysomnography to assess key variables such as arterial oxygen saturation, chest and abdomen respiratory movement, electroencephalogram findings and quantified air flow; all of these indices are subsequently used to determine the apnea—hypopnea index.

Figure 1. Screening and diagnostic algorithm for OSA. Full size image. Pathophysiological effects of OSA on the cardiovascular system OSA confers pathophysiological effects on the cardiovascular system through a variety of mechanisms Figure 2. Figure 2. Pathophysiological effects of OSA on the cardiovascular system.

Pathophysiological mechanisms of OSA on hypertension The relationship between OSA and hypertension has been extensively investigated 2 , 22 , 23 , 24 and there is compelling evidence to indicate that there is a dose—effect relationship 25 , 26 , 27 between the severity of in the OSA and degree of the BP elevation.

Figure 3. Pathophysiological mechanisms of OSA-associated hypertension. Different categories of hypertension related to OSA A substantial number of epidemiological studies have revealed that there are special categories of hypertension related to OSA; the most common and clinically relevant categories are resistant hypertension, nocturnal hypertension and masked hypertension.

OSA and nocturnal hypertension According to the circadian patterns of BP, high BP could be broadly classified into two categories: dipping and non-dipping. OSA and masked hypertension Masked hypertension is the term used to describe the condition when the BP measured in the office is within the target range but the BP assessed at home or by h ambulatory BP monitoring is above the normal range.

Approaches for managing OSA-associated hypertension In addition to anti-hypertensive drugs, there are some other highly effective non-pharmacologic modalities for treating OSA-associated hypertension.

Conclusion It is clinically important to screen for OSA in hypertensive patients, especially those patients who exhibit predominant diastolic BP elevation, difficult to control BP and nocturnal BP elevation.

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