Relação entre apneia obstrutiva do sono moderada à grave com disfunção metabólica sem influência nos níveis pressóricos em indivíduos obesos hipertensos

Abstract

Obstructive Sleep Apnea (OSA) may contribute to a higher cardiovascular risk in hypertensive patients. The present study aimed to identify differences in central blood pressure (BP) and in metabolic alterations between obese hypertensive patients with and without moderate/severe OSA. Obese hypertensive subjects were enrolled in a cross-sectional study. Based on apnea-hypopnea index (AHI) obtained with Watch-PAT200, a home device for sleep study, patients were divided into the group with absent/mild (AM) OSA (AHI<15) and with moderate/severe (MS) OSA (AHI&#8805;15). All patients were submitted to clinical and biochemical evaluation, peripheral and central BP measurements by radial applanation tonometry (SphygmoCor), and 24-h ambulatory blood pressure monitoring. Fifty-six patients completed the study, 32 (57%) in the group AM-OSA and 24 (43%) with MS-OSA (AHI=36±20 vs 8±4, p<0.001). Body mass index (34,8±3,5 vs 34,5±3,3 kg/m2, p=0,749) and abdominal circumference (110±11 vs 112±9 cm, p=0,564) were similar in both groups. Age (47±8 vs 54±8 years, p=0.004) and neck circumference (40.2±3.3 vs 42.7±4.5 cm, p=0.024) were significantly higher in the MS-OSA group. The same group presented a significant lower HDL-cholesterol (51±14 vs 44±9 mg/dl, p=0.033) and higher triglycerides (129±62 vs 173±95 mg/dl, p=0.049). There was no significant difference (p>0.05) in augmentation index (31±8 vs 28±9%) aortic systolic (121±15 vs 124±18mmHg), 24-h systolic (127±12 vs 129±20 mmHg) and 24-h diastolic (76±12 vs 77±13 mmHg) BP between the groups. In these obese hypertensive subjects, moderate/severe OSA did not show any direct relationship with central or ambulatory BP levels but it was associated with metabolic dysfunction, which can result in a higher cardiovascular risk in this population.