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May 23/30, 2012

Filling in the Pieces of the Sleep Apnea–Hypertension Puzzle

Author Affiliations

Author Affiliations: Departments of Medicine (Dr Kapur) and Otolaryngology–Head and Neck Surgery (Dr Weaver) and Sleep Center (Drs Kapur and Weaver), University of Washington, Seattle; and Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington (Dr Weaver).

JAMA. 2012;307(20):2197-2198. doi:10.1001/jama.2012.5039

Obstructive sleep apnea (OSA) is a common but underdiagnosed disorder that is associated with excessive sleepiness, poor quality of life, neurocognitive deficits, metabolic dysfunction, cardiovascular disease, and early mortality. Continuous positive airway pressure (CPAP) therapy efficaciously ameliorates obstructed breathing events.1 Randomized controlled trials (RCTs) show that CPAP therapy reduces sleepiness and improves quality of life in patients with moderate and severe OSA.2 A number of difficulties have complicated the assessment of the causal link between OSA and hypertension, including multiple shared risk factors, differential susceptibility of subgroups to the deleterious effects of OSA, and the challenges of conducting definitive RCTs. Despite these barriers, a significant evidence base has developed to support the identification and treatment of OSA in patients with hypertension. Multiple hypertension guidelines recognize OSA as a secondary cause of hypertension and specifically advise assessment and treatment of OSA in patients with refractory hypertension.3-5