Effects Of Mild Obstructive Sleep Apnea On Cardiovascular And Cerebrovascular Events In Patients With Hypertension

Objective Treat mild OSA can improve long-term prognosis has been controversial.Therefore,the purpose of this study was to investigate the effect of mild OSA-associated hypertension on major adverse cardiac and cerebrovascular events(MACCE).Methods 616 patients with hypertension admitted in department of hypertension at the People’s Hospital of Xin Jiang Uygur Autonomous Region from January 2010 to December 2010 were subjected in this study.According to the inclusion and exclusion criteria,495 patients were divided into three groups according to AHI(apnea hypopnea index),mild OSA with hypertension(n = 89)as case group,non-OSA group(n = 269)and moderate-severe OSA with hypertension group(n = 137)as control group.The average follow-up time was 7.5 ±2.3 years.365 patients were followed up in January to June 2019,Including mild OSA with hypertension group(n=66),non-OSA group(n=196)and moderate and severe OSA with hypertension group(n=103),and evaluated the difference in the incidence of MACCE among the three groups.Results 1.In patients with hypertension,the age,BMI,abdominal circumference,triglyceride,AHI,smoking history,impaired glucose tolerance/diabetes history and antiplatelet drug use history in OSA group were significantly higher than those in non-OSA group(P < 0.05).Mean blood oxygen saturation and minimum blood oxygen saturation in OSA group were significantly lower than those in non-OSA group(P < 0.05).The average follow-up time was 7.5 ±2.3 years,the incidence of MACCE was9.7% in non-OSA group,9.1% in mild OSA with hypertension group and 24.3% inmoderate-severe OSA with hypertension group(P < 0.001).Multivariate COX risk regression showed that the risk of MACCE in moderate-severe OSA with hypertension group was 2.54 times higher than that in mild OSA with hypertension group(HR=2.54,95%CI1.03-6.27,P=0.042),but there was no significant difference between mild OSA with hypertension group and non-OSA group(P > 0.05).Impaired glucose tolerance / history of diabetes also significantly increased the risk of MACCE(HR=2.73,95%CI1.52-4.88,P=0.001).2.Among patients with OSA related hypertension,the number of total cardiovascular and cerebrovascular events in the obese group(BMI ≥ 28Kg/m2)was significantly higher than that in the normal weight group(BMI<28Kg/m2).The multivariate COX regression method showed that the risk of cardiovascular and cerebrovascular events in the obese group was 3.47 times higher than that in the normal weight group(HR=3.47,95%CI =1.33-9.05,P=0.011).3.Among patients with OSA related hypertension,the total number of cardiovascular and cerebrovascular events in the middle and old age group(age ≥ 45 years)was significantly higher than that in the young group(age <45 years),but the difference was not statistically significant(P>,0.05).Multivariate COX regression analysis showed that after adjusting for gender and AHI,the risk of cardiovascular and cerebrovascular events was significantly higher in the elderly group than in the young group(HR=2.57,95%CI 1.13-5.86,P=0.024).conclusions1.In patients with hypertension,mild OSA does not increase the risk of MACCE,but the risk of MACCE associated with moderate-severe OSA is significantly increased.2.In patients with OSA related hypertension,obese patients have a significantly increased risk of cardiovascular and cerebrovascular events.3.Among patients with OSA related hypertension,the risk of cardiovascular andcerebrovascular events is significantly increased in middle-aged and elderly patients.