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Sleep Apnea Linked to More Severe Hypertension in Dialysis Patients: Presented at ASH

By Jill Stein

NEW YORK, NY -- May 16, 2002 -- Sleep apnea appears to be associated with a higher prevalence and severity of hypertension in patients undergoing hemodialysis, researchers reported here today at the 17^th Annual Scientific Meeting of the American Society of Hypertension (ASH).

Dr. Arun Kumar and a group from Case Western Reserve University in Cleveland, Ohio, conducted a cross-sectional study in 270 patients at several outpatient hemodialysis units.

"Hypertension is common, often poorly controlled, and contributes to increased cardiovascular morbidity in patients undergoing chronic hemodialysis," Dr. Kumar pointed out. "Although the relationship between sleep apnea and hypertension has been well studied in the general population, there are limited data in the dialysis population. The evidence that sleep apnea is associated with cardiovascular complications in end-stage renal disease patients is circumstantial."

His group therefore reasoned that sleep apnea may contribute to more severe hypertension in dialysis patients. In the study, the prevalence of sleep apnea in patients with end-stage renal disease on hemodialysis was determined using the Flemons screening criteria. Mean age of patients was 60±16 years and 54 percent were men. Seventy percent of patients were African American.

Results showed that the prevalence of sleep apnea in this high-risk group was high, with 37 percent of patients having an Apnea Hypopnea Index (AHI) greater than 10. Systolic and diastolic pressures were noted to be significantly higher in those with higher AHI scores. In patients with an AHI greater than 10, 63 percent had stage 1 hypertension or greater compared to 42 percent in patients with an AHI less than 10.

The study identified the high prevalence of sleep apnea in a dialysis population and the associated severe hypertension in this group, Dr. Kumar commented. Identifying sleep apnea as a cause for hypertension in this group may be an important adjunct in the management of refractory hypertension, he said.

While current literature emphasizes increased volume status as the single most important contributing factor to severe hypertension in a dialysis population, this study shows that non-volume related factors such as sleep apnea might play an important role as well, Dr. Kumar noted.

Use of therapeutic interventions like nasal continuous positive airway pressure may help to improve the effects of sympathetic activation associated with sleep apnea and perhaps permit better control of blood pressure, he concluded.

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