Age-dependent associations between sleep-disordered breathing and hypertension - Importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the sleep heart health study

Background - Sleep-disordered breathing (SDB) is associated with hypertension in the middle-aged. The association is less clear in older persons. Most middle-aged hypertensives have systolic/diastolic hypertension, whereas isolated systolic hypertension (ISH) is common among persons over 60 years. Mechanistically, only systolic/diastolic hypertension is expected to be associated with SDB, but few studies of SDB and hypertension distinguish systolic/diastolic hypertension from ISH. Prior investigations may have underestimated an association between SDB and systolic/diastolic hypertension in the elderly by categorizing individuals with ISH as simply hypertensive. Methods and Results - We conducted cross-sectional analyses of 6120 participants in the Sleep Heart Health Study, stratified by age: 40 to 59 (n = 2477) and greater than or equal to60 years. Outcome measures included apnea-hypopnea index (AHI; average number of apneas plus hypopneas per hour of sleep), systolic/diastolic hypertension (greater than or equal to140 and greater than or equal to90 mm Hg), and ISH (greater than or equal to140 and <90 mm Hg). With adjustment for covariates, ISH was not associated with SDB in either age category. In those aged <60 years, AHI was significantly associated with higher odds of systolic/diastolic hypertension (AHI 15 to 29.9, OR = 2.38 [95% CI 1.30 to 4.38]; AHI greater than or equal to30, OR = 2.24 [95% CI 1.10 to 4.54]). Among those aged greater than or equal to60 years, no adjusted association between AHI and systolic/diastolic hypertension was found. Conclusions - SDB is associated with systolic/diastolic hypertension in those aged <60 years. No association was found between SDB and systolic/diastolic hypertension in those aged >= 60 years or between SDB and ISH in either age category. These findings have implications for SDB screening and treatment. Distinguishing between hypertensive subtypes reveals a stronger association between SDB and hypertension for those aged <60 years than previously reported.