Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity, including hypertension. Beyond the severity of nocturnal hypoxia, other factors such as metabolic abnormalities but also sedentary behaviors and insufficient physical activity may contribute to elevated blood pressure (BP). To clarify the respective role of these factors as determinants of BP in OSA patients, we examined the relationship between BP and anthropometrics, severity of sleep apnea, and objectively measured physical activity and sedentary behaviors.
METHODS:
Ninety-five adults presenting with OSA (apnea-hypopnea index > 10 events/h) and high cardiovascular risk (63.3 ± 8.8 y; body mass index: 29.9 ± 4.9 kg/m2; apnea-hypopnea index: 41.3 ± 17.5/h; cardiovascular risk score: 13.5 ± 3.7%) were included. Physical activity and sedentary behaviors were objectively assessed by actigraphy, and self-measured home BP monitoring was measured. Logistic regression models adjusted for sex, age, and body mass index were built to identify the predictors of self-measured morning and evening BP.
RESULTS:
Physical activity was significantly related to obesity but not to the severity of sleep apnea or sleepiness. Sedentary behaviors were associated with self-measured morning and evening systolic BP (r = 0.32, P = .002; r = 0.29, P = .004). Steps per day were inversely associated with evening BP (r = −0.27, P = .01). Univariate analysis identified steps/d and time spent in vigorous physical activity as determinants for evening self-measured BP. In multivariate analysis, only steps/d were identified as a significant determinant of evening BP.
CONCLUSIONS:
Physical activity is the major determinant for evening BP in adults with OSA presenting high cardiovascular risk. Our results emphasize the need for lifestyle counseling programs in combination with CPAP to encourage regular physical activity in OSA subjects to obtain better BP control. (ClinicalTrials.gov registration NCT01226641.)
MarinJM, AgustiA, VillarI, FornerM, NietoD, CarrizoSJ, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA, 2012; 307(20):2169-2176.
2.
PeppardPE, YoungT, PaltaM, SkatrudJ. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000; 342(19):1378-1384.
TamisierR, PépinJL, RémyJ, BaguetJP, TaylorJA, WeissJW, LévyP. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J, 2011; 37(1):119-128.
5.
Cano-PumaregaI, Durán-CantollaJ, AizpuruF, Miranda-SerranoE, RubioR, Martínez-NullC, et al. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population; the Vitoria Sleep Cohort. Am J Respir Crit Care Med, 2011; 184(11):1299-1304.
6.
O'ConnorGT, CaffoB, NewmanAB, QuanSF, RapoportDM, RedlineS, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med, 2009; 179(12):1159-1164.
7.
BazzanoLA, KhanZ, ReynoldsK, HeJ. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension, 2007; 50(2):417-423.
8.
HaentjensP, Van MeerhaegheA, MoscarielloA, De WeerdtS, PoppeK, DupontA, VelkeniersB. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med, 2007; 167(8):757-764.
9.
BarbéF, Durán-CantollaJ, CapoteF, de la PeñaM, ChinerE, MasaJF, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med, 2010; 181(7):718-726.
10.
PépinJL, TamisierR, Barone-RochetteG, LaunoisSH, LévyP, BaguetJP. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am J Respir Crit Care Med, 2010; 182(7):954-960.
11.
HaskellWL, LeeIM, PateRR, PowellKE, BlairSN, FranklinBA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 2007; 116(9):1081-1093.
12.
WenCP, WaiJPM, TsaiMK, YangYC, ChengTY, LeeMC, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet, 2011; 378(9798):1244-1253.
13.
BassettDRJr, FitzhughEC, CrespoCJ, KingGA, McLaughlinJE. Physical activity and ethnic differences in hypertension prevalence in the United States. Prev Med, 2002; 34(2):179-186.
14.
PereiraMA, FolsomAR, McGovernPG, CarpenterM, ArnettDK, LiaoD, et al. Physical activity and incident hypertension in black and white adults: the Atherosclerosis Risk in Communities Study. Prev Med, 1999; 28(3):304-312.
15.
OwenN, HealyGN, MatthewsCE, DunstanDW. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev, 2010; 38(3):105-113.
16.
AadahlM, KjaerM, JørgensenT. Influence of time spent on TV viewing and vigorous intensity physical activity on cardiovascular biomarkers: the Inter 99 study. Eur J Cardiovasc Prev Rehabil, 2007; 14(5):660-665.
17.
BeunzaJJ, Martínez-GonzálezMA, EbrahimS, Bes-RastrolloM, NúñezJ, MartínezJA, AlonsoA. Sedentary behaviors and the risk of incident hypertension: the SUN Cohort. Am J Hypertens, 2007; 20(11):1156-1162.
18.
CintraF, PoyaresD, RizziCF, RissoTT, SkomroR, MontuoriE, et al. Cardiorespiratory response to exercise in men and women with obstructive sleep apnea. Sleep Med, 2009; 10(3):368-373.
19.
KatoM, PhillipsBG, SigurdssonG, NarkiewiczK, PesekCA, SomersVK. Effects of sleep deprivation on neural circulatory control. Hypertension, 2000; 35(5):1173-1175.
20.
TochikuboO, IkedaA, MiyajimaE, IshiiM. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension, 1996; 27(6):1318-1324.
21.
DeanE, BloomA, CirilloM, HongQ, JawlB, JukesJ, et al. Association between habitual sleep duration and blood pressure and clinical implications: a systematic review. Blood Press, 2012; 21(1):45-57.
22.
TaheriS, LinL, AustinD, YoungT, MignotE. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med, 2004; 1(3):e62.
23.
VoronaRD, WinnMP, BabineauTW, EngBP, FeldmanHR, WareJC. Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med, 2005; 165(1):25-30.
24.
AghamohammadzadehR, HeagertyAM. Obesity-related hypertension: epidemiology, pathophysiology, treatments, and the contribution of perivascular adipose tissue. Ann Med, 2012; 44Suppl 1:S74-S84.
25.
EckelRH, WassefM, ChaitA, SobelB, BarrettE, KingG, et al. Prevention Conference VI: diabetes and cardiovascular disease. Writing Group II: pathogenesis of atherosclerosis in diabetes. Circulation, 2002; 105(18):e138-e143.
26.
SchmidSM, HallschmidM, Jauch-CharaK, WilmsB, BenedictC, LehnertH, et al. Short-term sleep loss decreases physical activity under free-living conditions but does not increase food intake under time-deprived laboratory conditions in healthy men. Am J Clin Nutr, 2009; 90(6):1476-1482.
27.
HongS, DimsdaleJE. Physical activity and perception of energy and fatigue in obstructive sleep apnea. Med Sci Sports Exerc, 2003; 35(7):1088-1092.
28.
ConroyRM, PyoK, BackerGD, BacquerDD, DucimetieP, KeilU, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Science, 2003; 24(1):987-1003.
29.
ChalderT, BerelowitzG, PawlikowskaT, WattsL, WesselyS, WrightD, WallaceEP. Development of a fatigue scale. J Psychosom Res, 1993; 37(2):147-153.
ManciaG, De BackerG, DominiczakA, CifkovaR, FagardR, GermanoG, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens, 2007; 25(6):1105-1187.
32.
NICE. NICE guideline CG66: type 2 diabetes: the management of type 2 diabetes (updated May 2009). http://wwwniceorguk/CG66. Accessed March 17, 2012.
33.
WilliamsB, PoulterNR, BrownMJ, DavisM, McInnesGT, PotterJF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens, 2004; 18(3):139-185.
34.
MignaultD, St-OngeM, KarelisAD, AllisonDB, Rabasa-LhoretR. Evaluation of the Portable HealthWear Armband: a device to measure total daily energy expenditure in free-living type 2 diabetic individuals. Diabetes Care, 2005; 28(1):225-227.
35.
Sedentary Behaviour Research N. Standardized use of the terms “sedentary” and “sedentary behaviours.”. Appl Physiol Nutr Metab, 2012; 37(3):540-542.
36.
Tudor-LockeC. Steps to better cardiovascular health : how many steps does it take to achieve good health and how confident are we in this number?. Curr Cardiovasc Risk Rep, 2010; 4(4)271-276.
37.
NiiranenTJ, HänninenMR, JohanssonJ, ReunanenA, JulaAM. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension, 2010; 55(6):1346-1351.
38.
AsayamaK, OhkuboT, KikuyaM, ObaraT, MetokiH, InoueR, et al. Prediction of stroke by home “morning” versus “evening” blood pressure values: the Ohasama study. Hypertension, 2006; 48(4):737-743.
39.
O'DriscollDM, TurtonAR, CoplandJM, StraussBJ, HamiltonGS. Energy expenditure in obstructive sleep apnea: validation of a multiple physiological sensor for determination of sleep and wake. Sleep Breath, 2013; 17(1):139-146.
40.
WestSD, KohlerM, NicollDJ, StradlingJR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med, 2009; 10(9):1056-1058.
41.
JakicicJM, MarcusM, GallagherKI, RandallC, ThomasE, GossFL, RobertsonRJ. Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise. Med Sci Sports Exerc, 2004; 36(5):897-904.
42.
PittaF, TroostersT, ProbstVS, SpruitMA, DecramerM, GosselinkR. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J, 2006; 27(5):1040-1055.
43.
Van RemoortelH, GiavedoniS, RasteY, BurtinC, LouvarisZ, Gimeno-SantosE, et al. Validity of activity monitors in health and chronic disease: a systematic review. Int J Behav Nutr Phys Act, 2012; 9(1):84.
44.
Van RemoortelH, RasteY, LouvarisZ, GiavedoniS, BurtinC, LangerD, et al. Validity of six activity monitors in chronic obstructive pulmonary disease: a comparison with indirect calorimetry. PLoS One, 2012; 7(6):e39198.
45.
ParatiG, StergiouGS, AsmarR, BiloG, de LeeuwP, ImaiY, et al. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens, 2010; 24(12):779-785.
46.
BobrieG, ChatellierG, GenesN, ClersonP, VaurL, VaisseB, et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA, 2004; 291(11):1342-1349.
47.
BastaM, LinHM, PejovicS, SarrigiannidisA, BixlerE, VgontzasAN. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med, 2008; 4(1):19-25.
48.
GarrigueS, PépinJL, DefayeP, MurgatroydF, PoezevaraY, ClémentyJ, LévyP. High prevalence of sleep apnea syndrome in patients with long-term pacing: the European Multicenter Polysomnographic Study. Circulation, 2007; 115(13):1703-1709.
49.
FosterGD, SandersMH, MillmanR, ZammitG, BorradaileKE, NewmanAB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care, 2009; 32(6):1017-1019.
50.
HillJO, WyattHR. Role of physical activity in preventing and treating obesity. J Appl Physiol, 2005; 99(2):765-770.
51.
LukeA, DugasLR, Durazo-ArvizuRA, CaoG, CooperRS. Assessing physical activity and its relationship to cardiovascular risk factors: NHANES 2003-2006. BMC Public Health, 2011; 11:387.
52.
PedrosaRP, DragerLF, GonzagaCC, SousaMG, de PaulaLKG, AmaroACS, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension, 2011; 58(5):811-817.
53.
ChobanianAV, BakrisGL, BlackHR, CushmanWC, GreenLA, IzzoJL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003; 289(19):2560-2572.
54.
MenottiA, BlackburnH, KromhoutD, NissinenA, AdachiH, LantiM. Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study. Eur J Epidemiol, 2001; 17(4):337-346.
55.
ThorpAA, OwenN, NeuhausM, DunstanDW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev Med, 2011; 41(2):207-215.
56.
PouliouT, KiM, LawC, LiL, PowerC. Physical activity and sedentary behaviour at different life stages and adult blood pressure in the1958 British cohort. J Hypertens, 2012; 30(2):275-283.
57.
SavicaV, BellinghieriG, KoppleJD. The effect of nutrition on blood pressure. Annu Rev Nutr, 2010; 30:365-401.
58.
DragerLF, Lorenzi-FilhoG. CPAP for obstructive sleep apnea and the metabolic syndrome. N Engl J Med, 2012; 366(10):964; author reply 965-966.
59.
HoyosCM, KillickR, YeeBJ, PhillipsCL, GrunsteinRR, LiuPY. Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study. Thorax, 2012; 67(12)1081-1089.
60.
AwadKM, MalhotraA, BarnetJH, QuanSF, PeppardPE. Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med, 2012; 125(5):485-490.
61.
GiebelhausV, StrohlKP, LormesW, LehmannM, NetzerN. Physical exercise as an adjunct therapy in sleep apnea: an open trial. Sleep Breath, 2000; 4(4):173-176.
62.
PeppardPE, YoungT. Exercise and sleep-disordered breathing: an association independent of body habitus. Sleep, 2004; 27(3):480-484.
63.
SengulYS, OzalevliS, OzturaI, ItilO, BaklanB. The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath, 2011; 15(1):49-56.
