Document Detail

Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study.
MedLine Citation:
PMID:  18617307     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Microalbuminuria reflects a state of widespread vascular dysfunction, whereas obstructive sleep apnea (OSA) further promotes atherosclerotic damage in hypertension.
STUDY DESIGN: Cross-sectional.
SETTING & PARTICIPANTS: 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.
PREDICTOR VARIABLE: Hypertension and OSA compared with hypertension without OSA. OSA defined as AHI greater than 5, documented by polysomnography.
OUTCOME VARIABLE: Albuminuria assessed by urinary albumin-creatinine ratio (ACR).
MEASUREMENTS: 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.
RESULTS: 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; P < 0.001). In the entire study population, log10(ACR) correlated with log10(AHI) (r = 0.35; P < 0.001), minimum oxygen saturation during sleep (r = -0.33; P < 0.001), 24-hour pulse pressure (r = 0.38; P < 0.001), 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; P < 0.001) and 24-hour pulse pressure (beta = 0.25; P = 0.01).
LIMITATIONS: Cross-sectional study.
CONCLUSIONS: 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.
Costas Tsioufis; Costas Thomopoulos; Kyriakos Dimitriadis; Anastasia Amfilochiou; Dimitris Tsiachris; Maria Selima; Dimitris Petras; Ioannis Kallikazaros; Christodoulos Stefanadis
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-07-09
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  52     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-08-05     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-93     Citation Subset:  IM    
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MeSH Terms
Albuminuria / complications*,  epidemiology,  urine
Blood Pressure
Blood Pressure Monitoring, Ambulatory
Cross-Sectional Studies
Electrocardiography, Ambulatory
Hypertension / complications*,  epidemiology,  urine
Middle Aged
Retrospective Studies
Risk Factors
Severity of Illness Index
Sleep Apnea, Obstructive / epidemiology,  etiology*,  physiopathology
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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