The Influence of the Severity of Obstructive Sleep Apnea on the Incidence of Hypertension

Authors

  • Marchella Tjandra Family Medicine Department, University of Pelita Harapan, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Indonesia 15811
  • Shirley Ivonne Moningkey Family Medicine Department, University of Pelita Harapan, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Indonesia 15811
  • Hendyono Lim Cardiology Department, Faculty of Medicine, University of Pelita Harapan, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Indonesia 15811

DOI:

https://doi.org/10.19166/med.v14i2.9546

Keywords:

Obstructive Sleep Apnea (OSA), Hypertension, Severity, Polysomnography, Risk Factors

Abstract

Background : Hypertension is a condition where systolic blood pressure reaches 140 mmHg, and diastolic blood pressure reaches 90 mmHg. According to the Ministry of Health of Republic Indonesia, hypertension ranks third as a cause of death in Indonesia. Secondary hypertension arises from identifiable causes such as obstructive sleep apnea, renal vascular disease, hormonal contraceptives, endocrine disorders, stress-induced hypertension, pregnancy, burns, renal parenchymal disease, polycystic ovarian syndrome, preeclampsia, and specific medications like NSAIDs and antidepressants. Previous studies have recorded 83% Hypertension patients had OSA. Despite these findings, there are still contradictions in the literature (7), indicating the need for further research to explore the relationship between OSA and hypertension, as well as the impact of different types of OSA on hypertension.

Methods : This research is an observational analytic study using a cross-sectional method. Medical status data and polysomnography results were collected from February to April 2024 at Siloam Hospitals Lippo Village. Data were processed using SPSS 23.0 and analyzed using the chi-square method. Significant variables will be further analyzed using logistic multivariate analysis.

Result : There was an influence of the severity of Obstructive Sleep Apnea on the incidence of hypertension at Siloam Hospitals Lippo Village (OR=15.4, 95%CI 3.477 – 68.216; p-value=0.001). Besides the influence of the severity of Obstructive Sleep Apnea, other variables such as gender, BMI ≥ 23 kg/m², and a history of diabetes mellitus also affected the incidence of hypertension.

Conclusion : The influence of the severity of Obstructive Sleep Apnea on the incidence of hypertension found in Siloam Hospitals Lippo Village.

References

1. World Health Organization. Hypertension [Internet]. 2023 [cited 2023 Nov 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension

2. Kementerian Kesehatan Republik Indonesia. Fakta dan Angka Hipertensi [Internet]. 2017 [cited 2023 Nov 9]. Available from: https://p2ptm.kemkes.go.id/kegiatan-p2ptm/subdit-penyakit-jantung-dan-pembuluh-darah/fakta-dan-angka-hipertensi

3. Kementerian Kesehatan Republik Indonesia. Klasifikasi Hipertensi. 2018.

4. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LKG, Amaro ACS, et al. Obstructive Sleep Apnea. Hypertension. 2011 Nov; 58(5): 811–7. https://doi.org/10.1161/hypertensionaha.111.179788

5. Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Mo Med. 2017;114(2):120–4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6140019/

6. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010 Jan;90(1):47–112. https://doi.org/10.1152/physrev.00043.2008

7. Benin M. The Severity of Obstructive Sleep Apnea and Hypertension Among Middle aged Asians. Walden Dissertations and Doctoral Studies. 2015: 1772. https://scholarworks.waldenu.edu/dissertations/1772

8. Kadarullah O, Annisa Y. Pengaruh Obstructive Sleep Apnea (OSA) Terhadap Terjadinya Hipertensi Di Poli Saraf RSUD Prof. Dr. Margono Soekarjo. Sainteks. 2016; 13(2): 11-20. https://dx.doi.org/10.30595/sainteks.v13i2.1500

9. Nalle TS, Putra DG. Hubungan diabetes mellitus dengan obstructive sleep apnea (OSA) di Gedung Mario Tabanan, Bali-Indonesia. Intisari Sains Medis. 2021; 12(1): 88–91. https://www.isainsmedis.ejournals.ca/index.php/ism/article/view/884/742

10. Jo JH, Park JW, Jang JH, Chung JW. Polysomnographic and Cephalometric Evaluation of Patients with Obstructive Sleep Apnea According to Obesity Level. J Oral Med Pain. 2022 Sep 30;47(3):135–43. https://doi.org/10.14476/jomp.2022.47.3.135

11. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. European Respiratory Journal. 2013 Mar; 41(3): 523–38. https://doi.org/10.1183/09031936.00226711

12. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J. Population-Based Study of Sleep-Disordered Breathing as a Risk Factor for Hypertension. Arch Intern Med. 1997 Aug 11; 157(15): 1746-1752. https://sleepcohort.wisc.edu/wp-content/uploads/sites/1452/2020/10/htn.pdf

13. Subkhi M. Hubungan pola makan dengan kejadian hipertensi pada lansia di Posyandu Mawar Desa Sangubanyu Kabupaten Purworejo [Tesis]. Yogyakarta: Universitas ‘Aisyiyah Yogyakarta; 2016.

14. Edwards BA, Wellman A, Sands SA, Owens RL, Eckert DJ, White DP, et al. Obstructive Sleep Apnea in Older Adults is a Distinctly Different Physiological Phenotype. Sleep. 2014 Jul 1; 37(7): 1227-1236. https://doi.org/10.5665/sleep.3844

15. Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. European Respiratory Journal. 2022 Apr; 59(4): 2101649. https://doi.org/10.1183/13993003.01649-2021

16. Lydia A, Setiati S, Soejono CH, Istanti R, Marsigit J, Azwar MK. Prevalence of prehypertension and its risk factors in midlife and late life: Indonesian family life survey 2014–2015. BMC Public Health. 2021 Dec 12; 21(1) :493. https://doi.org/10.1186/s12889-021-10544-y

17. Oktamianti P, Kusuma D, Amir V, Tjandrarini DH, Paramita A. District-Level Inequalities in Hypertension among Adults in Indonesia: A Cross-Sectional Analysis by Sex and Age Group. Int J Environ Res Public Health. 2022 Oct 14; 19(20): 13268. https://doi.org/10.3390/ijerph192013268

18. Shannon OM, Clifford T, Seals DR, Craighead DH, Rossman MJ. Nitric oxide, aging and aerobic exercise: Sedentary individuals to Master’s athletes. Nitric Oxide. 2022 Aug;125–126: 31–39. https://doi.org/10.1016/j.niox.2022.06.002

19. Torregrossa AC, Aranke M, Bryan NS. Nitric oxide and geriatrics: Implications in diagnostics and treatment of the elderly. Journal of Geriatric Cardiology. 2012 Jan 13; 8(4): 230–242. https://doi.org/10.3724/sp.j.1263.2011.00230

20. Sverdlov AL, Ngo DTM, Chan WPA, Chirkov YY, Horowitz JD. Aging of the Nitric Oxide System: Are We as Old as Our NO? J Am Heart Assoc. 2014 Aug 15;3(4): e000973. https://doi.org/10.1161/JAHA.114.000973

21. Linggar EZ, Irwan, Yunita M, Ruspanah I, Kadun A, Starlia F, Malakauseya M, Siahaya N. Prevalence and Factors Associated with Hypertension in the Coastal Com- munity of Laha Village: A Cross-Sectional Study. Nusantara Science and Technology Proceedings, 1st International Conference on Health and Medicine. 2023. https://doi.org/10.11594/nstp.2023.3510

22. Lydia A, Setiati S, Soejono CH, Istanti R, Marsigit J, Azwar MK. Prevalence of prehypertension and its risk factors in midlife and late life: Indonesian family life survey 2014–2015. BMC Public Health. 2021 Dec 12; 21(1) :493. https://doi.org/10.1186/s12889-021-10544-y

23. Silva MdS, Poyares D, Silva LO, Souza KM, Andersen ML, Ohayon MM, et al. Associations of the Severity of Obstructive Sleep Apnea With Age-Related Comorbidities: A Population-Based Study. Front Neurol. 2022 May 10; 13: 802554. https://doi.org/10.3389/fneur.2022.802554

24. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes. Chest. 2017 Nov; 152(5): 1070–86. https://doi.org/10.1016/j.chest.2017.05.009

25. Nalle TS, Putra DG. Hubungan diabetes mellitus dengan obstructive sleep apnea (OSA) di Gedung Mario Tabanan, Bali-Indonesia. Intisari Sains Medis. 2021; 12(1): 88–91. https://www.isainsmedis.ejournals.ca/index.php/ism/article/view/884/742

26. Mok Y, Tan C, Wong H, How C, Tan K, Hsu P. Obstructive sleep apnoea and Type 2 diabetes mellitus: are they connected? Singapore Med J. 2017 Apr; 58(4): 179–83. https://doi.org/10.11622/smedj.2017027

27. Epstein M, Sowers JR. Diabetes Mellitus and Hypertension. Hypertension. 1992; 19(5): 403-18. https://doi.org/10.1161/01.hyp.19.5.403

28. Oktaviyani P, Salman, Sari MH, Frisilia M, Munazar, Satria A, Maretalinia. Prevalence and Risk Factors of Hypertension and Diabetes Mellitus among the Indonesian Elderly. Makara Journal of Health Research. 2022 Apr 26; 26(1): 7-11. https://doi.org/10.7454/msk.v26i1.1329

29. Jia G, Sowers JR. Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease. Hypertension. 2021 Nov; 78(5): 1197–205. https://doi.org/10.1161/hypertensionaha.121.17981

30. Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, et al. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord. 2017; 1(4): 00019. https://pubmed.ncbi.nlm.nih.gov/29517065/

31. Jo JH, Park JW, Jang JH, Chung JW. Polysomnographic and Cephalometric Evaluation of Patients with Obstructive Sleep Apnea According to Obesity Level. J Oral Med Pain. 2022 Sep 30;47(3):135–43. https://doi.org/10.14476/jomp.2022.47.3.135

32. Mulyasari I, Afiatna P, Maryanto S, Aryani AN. Indeks Massa Tubuh (IMT) Sebagai Prediktor Hipertensi: Perbandingan Standar WHO dan Asia-Pasifik. Amerta Nutrition. 2023 Dec 31; 7(2SP): 247–51. http://dx.doi.org/10.20473/amnt.v7i2SP.2023.247-251

33. Nguyen TT, Adair LS, Suchindran CM, He K, Popkin BM. The association between body mass index and hypertension is different between East and Southeast Asians. Am J Clin Nutr. 2009 Jun; 89(6): 1905–12. https://doi.org/10.3945/ajcn.2008.26809

34. Shakeri N, Azizi F. Estimating the Cutoff Points of Time-Dependent Risk Factors by Using Joint Modeling of Longitudinal and Time-to-Event Data: A 14-Year Follow-up Study-Tehran Lipid and Glucose Study. Asia Pac J Public Health. 2019 Nov;31(8): 728-736. https://doi.org/10.1177/1010539519889767

35. Shariq OA, McKenzie TJ. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surg. 2020 Feb; 9(1): 80–93. https://doi.org/10.21037/gs.2019.12.03

36. Lee SH, Park YM, Han K, Yang JH, Lee S, Lee S, et al. Obesity-related hypertension: Findings from The Korea National Health and Nutrition Examination Survey 2008–2010. PLoS One. 2020 Apr 21; 15(4): e0230616. https://doi.org/10.1371/journal.pone.0230616

37. Hossain FB, Adhikary G, Chowdhury AB, Shawon MdS. Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally representative surveys. Clin Hypertens. 2019 Dec 15; 25: 28. https://doi.org/10.1186/s40885-019-0134-8

38. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Sex-dependent GOAL screening performance in adults at risk for obstructive sleep apnea. Pulmonology. 2024 May; 30(3): 265–71. https://doi.org/10.1016/j.pulmoe.2022.01.004

39. Reckelhoff JF. Gender Differences in the Regulation of Blood Pressure. Hypertension. 2001 May; 37(5):1199–208. https://doi.org/10.1161/01.hyp.37.5.1199

40. Bryan NS. Nitric oxide deficiency is a primary driver of hypertension. Biochem Pharmacol. 2022 Dec; 206: 115325. https://doi.org/10.1016/j.bcp.2022.115325

41. Defianna SR, Santosa A, Probandari A, Dewi FST. Gender Differences in Prevalence and Risk Factors for Hypertension among Adult Populations: A Cross-Sectional Study in Indonesia. Int J Environ Res Public Health. 2021 Jun 9;18(12):6259. https://doi.org/10.3390/ijerph18126259

42. Falah M. Hubungan Jenis Kelamin Dengan Angka Kejadian Hipertensi Pada Masyarakat Di Kelurahan Tamansari Kota Tasikmalaya. 2019 May; 3(1): 85-94. https://doi.org/10.54440/jmk.v3i1.67

43. Kusumawaty J, Hidayat N, Ginanjar E. Hubungan Jenis Kelamin dengan Intensitas Hipertensi pada Lansia di Wilayah Kerja Puskesmas Lakbok Kabupaten Ciamis. Mutiara Medika. 2016 Jul; 16(2): 46-51. https://doi.org/10.18196/mmjkk.v16i2.4450

Downloads

Published

2025-02-24

Issue

Section

Clinical Research