The prevalence and awareness of hypertension and the relationship between hypertension and snoring in the Korean population

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

BACKGROUND

Epidemiological studies have revealed an association between obstructive sleep apnea (OSA) and hypertension in the general population, while the association in military personnel was rarely investigated.

AIM

To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.

METHODS

A total of 746 military personnel, aged 27.9 years, were included in the cardiorespiratory fitness and health in armed forces (CHIEF)-sleep study in Taiwan in 2020. Antihypertensive medications were not used by the subjects. High risk for OSA was assessed using the Berlin Questionnaire. Hypertension was defined using the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. The cutoff levels of systolic and diastolic blood pressure (SBP and DBP) for the 2017 ACC/AHA- and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg, respectively. Hypertension phenotypes included isolated systolic and diastolic hypertension (ISH, high SBP only and IDH, high DBP only) and combined hypertension (both high SBP and DBP). Multivariable logistic regression analysis with adjustment for demographics, lifestyle and metabolic biomarkers.

RESULTS

The prevalence of high risk for OSA, JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%, 5.2% and 22.0%, respectively. Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension (odds ratios (ORs) and 95% confidence intervals: 2.82 (1.07-7.42) and 7.54 (1.10-51.54), although the probabilities of ISH and IDH were unaffected by a high risk for OSA (ORs: 1.96 and 2.35, respectively, both P > 0.05). In contrast, no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.

CONCLUSION

A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

Association between self-reported snoring and hypertension among Chinese Han population aged 30-79 in Chongqing, China

Background

We aim to explore the association between self-reported snoring and hypertension among adults aged 30–79 in Chongqing, China.

Methods

A total of 23,342 individuals aged 30–79 were included at baseline from August 2018 to January 2019, and the final sample size for the analysis was 22,423. Face-to-face interviews and physical examinations were conducted by trained investigators. Logistic regression was performed to study age-specific and gender-specific associations between snoring and hypertension.

Results

Frequent snoring was associated with the risk of hypertension for each age and gender group, and the frequency of snoring was positively correlated with the risk for hypertension. For the three age groups (< 45, 45–59, ≥ 60), compared with the non-snoring group, those who snore often had a 64.5%, 53.3%, and 24.5% increased risk of hypertension (< 45: OR = 1.65, 95%CI 1.34–2.02; 45–59: OR = 1.53, 95%CI 1.37–1.72; ≥ 60: OR = 1.25, 95%CI 1.09–1.42), respectively. For men and women, those who snore often had a 46.8% and 97.2% increased risk of hypertension, respectively, than the non-snoring group (men: OR = 1.47, 95%CI 1.33–1.63; women: OR = 1.97, 95%CI 1.75–2.23).

Conclusions

People who snore frequently should pay close attention to their blood pressure levels in order to achieve early prevention of hypertension, particularly for snorers who are female and aged under 45; importance should be attached to their blood pressure control.

Sleep and hypertension

PURPOSE

Hypertension is a global public issue, and sleep status was regarded as its risk factor; however, the results were inconsistent. This study aims to deeply investigate the correlation between sleep status and hypertension.

METHODS

The electronic databases Cochrane Library, Pubmed, and Embase updated to May 31, 2019, were retrieved. Studies were selected according to the predefined screening criteria, and their qualities were assessed by using quality check scales. Based on Stata 15.1 software, the associations between sleep status and hypertension were analyzed by meta-analyses, using odds ratio and 95% confidence interval as effect indexes. Furthermore, publication bias and small study bias were evaluated using Begg and Egger's test. In addition, sensitivity analysis was conducted through ignoring one study per time and then observing its influences on the pooled results.

RESULTS

A total of 54 studies (involving 1,074,207 subjects) were eligible for this meta-analysis. Six factors were included in this study. Raised blood pressure was associated with obstructive sleep apnea (OSA), oxygen desaturation index (ODI), short sleep duration, and long sleep duration. The differences in ≤ 5 h, 6 h, ≥ 9 h, and 10 h groups had statistical significances, while there was no significant difference in ≥ 8 h group. Snoring is a risk factor of hypertension (OR = 1.94, 95%CI 1.41-2.67). Subgroup analysis was conducted and results were varied.

CONCLUSIONS

The hypertension risk might be reduced by treated OSA, ODI, and snoring, as well as appropriate sleep duration. More studies with large sample sizes and high qualities should be included to support the findings further.

High risk for obstructive sleep apnea in relation to hypertension among southeast Asian young adults: role of obesity as an effect modifier

BACKGROUND

Obstructive sleep apnea (OSA) has been linked to hypertension among middle-aged and older adults in Western countries. Few studies have focused on young adults, especially those in Southeast Asian countries undergoing epidemiologic transitions and experiencing elevated noncommunicable disease burden. We investigated associations of high risk for OSA with hypertension among Asian young adults.

METHODS

A total of 2,911 college students in Thailand participated in this study. The high risk for OSA was assessed using the Berlin Questionnaire. Blood pressure (BP) and anthropometric measurements were taken by trained research staff. Elevated BP and hypertension were defined as BP ≥ 120/80 mm Hg and ≥ 140/90 mm Hg, respectively. Multivariable logistic regression models were fit to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of elevated BP and hypertension. Stratified analyses were conducted to examine whether observed associations varied by weight status.

RESULTS

High risk for OSA was significantly associated with elevated BP (OR = 2.38; 95% CI = 1.68-3.39) and hypertension (OR = 2.55; 95% CI = 1.57-4.15) after adjustment for demographic and lifestyle factors. When body mass index was further controlled for, observed associations were greatly attenuated. The associations were only evident among overweight and obese students.

CONCLUSIONS

The high risk for OSA among overweight and obese young adults is associated with elevated BP and hypertension. Enhanced efforts directed toward screening and diagnosing OSA and weight control among young adults could be one strategy for improving cardiovascular health.

Prevalence and association of snoring, anthropometry and hypertension in Korea

OBJECTIVES

There is little data on the relationships between hypertension and snoring in Asians, whose anthropometrics and prevalence of diseases are different from Western populations. This study evaluated the prevalence and the factors associated with snoring in an adult Korean population (18 years).

METHODS

The questions on snoring were divided into five Likert scales ["never" to "severe"(everyday)]. Subjects were divided into two mutually exclusive groups: moderate and severe groups of snorers considered habitual snorers, and never, sometimes and mild snorers considered the non-snoring group. We classified the severity of hypertension according to JNC 6. Independent variables included demographic and baseline characteristics, hypertension, anthropometrics, current medical history, medications and substance use.

RESULTS

Overall prevalence of habitual snoring is 15.58% in males and 8.40% in females. The mean age, body mass index (BMI), both systolic and diastolic blood pressure, and anthropometric data, including neck, chest and abdominal girth, were significantly associated with the snoring group in both men and women. Neck length was only significantly shorter in females, not in males. Alcohol consumption rate was significantly higher in the snoring group of the men, but was lower in the snoring group in women. Smoking did not show any significant relationship with snoring and non-snoring groups in both genders. Snoring was significantly higher in the menopause group (odds ratio 2.8) than the premenopausal group. Fifty per cent in the snoring group and 33.08% in the non-snoring group were diagnosed as having hypertension. The prevalence of hypertension was significantly higher in the snoring group aged<40 years and was weakly significant in those subjects aged between 40 and 60 years in males. The prevalence of hypertension was significantly higher in the snoring group in those both aged<40 years and those aged between 40 and 60 years in females. Those aged>60 years old in both genders showed no significant differences in the prevalence of hypertension between snorers and non-snorers. The relationship between hypertension and snoring after adjustments for age, BMI, age, smoke and alcohol usage showed a dose-response relationship in both genders.

CONCLUSIONS

This study showed the dose-response relationship between hypertension and snoring, even after adjustments for age, BMI, age, smoke and alcohol usage. Snoring significantly increased after menopause in women. Snoring had a significant relationship with neck length in females but not in males. There is a dose-response relationship between snoring and hypertension in both genders in those subjects aged<60 years old.