Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex
Objectives Obstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males...
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doaj-1c8f42f28bb746daab7c3bbcb53658912021-07-02T13:07:52ZengBMJ Publishing GroupBMJ Open2044-60552021-03-0111310.1136/bmjopen-2020-041179Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sexEunjoo An0Michael R Irwin1Lynn V Doering2Mary-Lynn Brecht3Karol E Watson4Ravi S Aysola5Andrea P Aguila6Ronald M Harper7Paul M Macey8UCLA School of Nursing, University of California, Los Angeles, Los Angeles, California, USADepartment of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USAUCLA School of Nursing, University of California, Los Angeles, Los Angeles, California, USAUCLA School of Nursing, University of California, Los Angeles, Los Angeles, California, USADepartment of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, USADivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, USAUCLA School of Nursing, University of California, Los Angeles, Los Angeles, California, USADepartment of Neurobiology, University of California, Los Angeles, Los Angeles, California, USAUCLA School of Nursing, University of California, Los Angeles, Los Angeles, California, USAObjectives Obstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males.Design Retrospective analysis of electronic health records (EHR) over 10 years (2006–2015 inclusive).Setting University of California Los Angeles (UCLA) Health System in Los Angeles, California, USA.Participants 4848 patients: females n=2086, mean (SD) age=52.8 (13.2) years; males n=2762, age=53.8 (13.5) years. These patients were selected from 1.6 million with diagnoses in the EHR who met these criteria: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least 1 year prior and 1 year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA.Primary and secondary outcome measures The primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (OSA to HTN days). Since HTN and OSA are progressive disorders, a secondary measure was the relationship between OSA to HTN time and age (OSA to HTN=β1×Age+β0).Results The median (lower and upper quartiles) days from OSA to HTN were: all −532 (−1439, –3); females −610 (−1579, –42); and males −451 (−1358, 0). Older age in both sexes was associated with less time to a subsequent HTN diagnosis or more time from a prior HTN diagnosis (β1 days/year: all −16.9, females −18.3, males −15.9).Conclusions HTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings are consistent with underscreening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN.https://bmjopen.bmj.com/content/11/3/e041179.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eunjoo An Michael R Irwin Lynn V Doering Mary-Lynn Brecht Karol E Watson Ravi S Aysola Andrea P Aguila Ronald M Harper Paul M Macey |
spellingShingle |
Eunjoo An Michael R Irwin Lynn V Doering Mary-Lynn Brecht Karol E Watson Ravi S Aysola Andrea P Aguila Ronald M Harper Paul M Macey Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex BMJ Open |
author_facet |
Eunjoo An Michael R Irwin Lynn V Doering Mary-Lynn Brecht Karol E Watson Ravi S Aysola Andrea P Aguila Ronald M Harper Paul M Macey |
author_sort |
Eunjoo An |
title |
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex |
title_short |
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex |
title_full |
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex |
title_fullStr |
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex |
title_full_unstemmed |
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex |
title_sort |
which came first, obstructive sleep apnoea or hypertension? a retrospective study of electronic records over 10 years, with separation by sex |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2021-03-01 |
description |
Objectives Obstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males.Design Retrospective analysis of electronic health records (EHR) over 10 years (2006–2015 inclusive).Setting University of California Los Angeles (UCLA) Health System in Los Angeles, California, USA.Participants 4848 patients: females n=2086, mean (SD) age=52.8 (13.2) years; males n=2762, age=53.8 (13.5) years. These patients were selected from 1.6 million with diagnoses in the EHR who met these criteria: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least 1 year prior and 1 year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA.Primary and secondary outcome measures The primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (OSA to HTN days). Since HTN and OSA are progressive disorders, a secondary measure was the relationship between OSA to HTN time and age (OSA to HTN=β1×Age+β0).Results The median (lower and upper quartiles) days from OSA to HTN were: all −532 (−1439, –3); females −610 (−1579, –42); and males −451 (−1358, 0). Older age in both sexes was associated with less time to a subsequent HTN diagnosis or more time from a prior HTN diagnosis (β1 days/year: all −16.9, females −18.3, males −15.9).Conclusions HTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings are consistent with underscreening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN. |
url |
https://bmjopen.bmj.com/content/11/3/e041179.full |
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