Association Between Arousals During Sleep and Hypertension Among Patients With Obstructive Sleep Apnea

Rong Ren, Ye Zhang, Linghui Yang, Virend K. Somers, Naima Covassin, Xiangdong Tang

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Sleep fragmentation induced by repetitive arousals is a hallmark of obstructive sleep apnea (OSA). Sleep fragmentation has been linked to hypertension in community-based studies, but it is unclear if this association is manifest in OSA. We aimed to explore whether frequent arousals from sleep modify the relationship between OSA and prevalent hypertension. METHODS AND RESULTS: A total of 10 102 patients with OSA and 1614 primary snorers were included in the study. Hypertension was defined on either direct blood pressure measures or diagnosis by a physician. Spontaneous, respiratory, and movement arousals were derived by polysomnography. Logistic regression models were used to estimate the associations between arousals and prevalent hypertension in patients with OSA and primary snorers. For every 10-unit increase of total arousal index, odds of hypertension significantly increased in both the total sample (odds ratio [OR], 1.08; 95% CI, 1.03–1.14; P=0.002) and patients with OSA (OR, 1.10; 95% CI, 1.04–1.16; P<0.001), but not in the primary snoring group. Total arousal index was significantly associated with systolic blood pressure and diastolic blood pressure in the total sample (β=0.05 and β=0.06; P<0.001) and in patients with (β=0.05 and β=0.06; P<0.01), but not in primary snorers. In addition, a greater influence of respiratory events with arousals than respiratory events without arousals on blood pressure in OSA was also noted. Results were independent of confounders, including apnea-hypopnea index and nocturnal hypoxemia. CONCLUSIONS: We conclude that repetitive arousals from sleep are independently associated with prevalent hypertension in patients with OSA.

Original languageEnglish (US)
Article numbere022141
JournalJournal of the American Heart Association
Issue number1
StatePublished - Jan 4 2022


  • High blood pressure
  • Hypertension
  • Obstructive sleep apnea
  • Repetitive arousals
  • Sleep fragmentation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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