Polysomnographic predictors of blood pressure and hypertension: Is one index best?

Susan Redline, Nancy I. Min, Eyal Shahar, David Rapoport, George O'Connor

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Study Objectives: Numerous indexes derived from polysomnography are available to characterize sleep-disordered breathing, with no consensus over which measures best predict clinical outcomes. This study addresses the relative merits of using alternative polysomnography indexes by characterizing the consistency and strength of the association of each index with blood pressure and hypertension. Design: Cross-sectional analyses of the association of alternative polysomnography indexes with blood pressure and hypertension were performed in construction and validation data sets. Linear and logistic regression models were used to identify the best variable sets. Patients: Data were obtained from 6433 men and women (age 62.9 ± 11.0 years, 52.8% women) who participated in the Sleep Heart Health Study. Results: In multivariable models, most indexes showed weak linear associations with systolic, with slightly stronger associations for diastolic blood pressure, and the log odds of hypertension. No single index showed consistent superiority over others. Systolic blood pressure, diastolic blood pressure, and hypertension each were associated with distinct sets of polysomnography variables. Slightly more-consistent associations were demonstrated for indexes that included hypopneas that were linked with either a 3% or 4% desaturation level than indexes that did not require hypopneas to have linked desaturation. For indexes that combined apneas and hypopneas, there was no evidence that linking obstructive apneas to desaturation or arousal altered prediction compared with counting all apneas. Conclusion: In summary, using a rigorous cross-validation assessment, we did not identify a clear superiority of any single index for blood pressure or hypertension prediction. Detailed analyses of alternative definitions of the respiratory disturbance index support current scoring guidelines, where desaturation criteria are recommended for hypopneas but not apneas.

Original languageEnglish (US)
Pages (from-to)1122-1130
Number of pages9
JournalSleep
Volume28
Issue number9
StatePublished - Sep 1 2005
Externally publishedYes

Fingerprint

Blood Pressure
Hypertension
Polysomnography
Apnea
Logistic Models
Sleep Apnea Syndromes
Arousal
Linear Models
Consensus
Sleep
Cross-Sectional Studies
Guidelines
Health

Keywords

  • Blood pressure
  • Hypertension
  • Scoring
  • Sleep apnea

ASJC Scopus subject areas

  • Physiology

Cite this

Redline, S., Min, N. I., Shahar, E., Rapoport, D., & O'Connor, G. (2005). Polysomnographic predictors of blood pressure and hypertension: Is one index best? Sleep, 28(9), 1122-1130.

Polysomnographic predictors of blood pressure and hypertension : Is one index best? / Redline, Susan; Min, Nancy I.; Shahar, Eyal; Rapoport, David; O'Connor, George.

In: Sleep, Vol. 28, No. 9, 01.09.2005, p. 1122-1130.

Research output: Contribution to journalArticle

Redline, S, Min, NI, Shahar, E, Rapoport, D & O'Connor, G 2005, 'Polysomnographic predictors of blood pressure and hypertension: Is one index best?', Sleep, vol. 28, no. 9, pp. 1122-1130.
Redline S, Min NI, Shahar E, Rapoport D, O'Connor G. Polysomnographic predictors of blood pressure and hypertension: Is one index best? Sleep. 2005 Sep 1;28(9):1122-1130.
Redline, Susan ; Min, Nancy I. ; Shahar, Eyal ; Rapoport, David ; O'Connor, George. / Polysomnographic predictors of blood pressure and hypertension : Is one index best?. In: Sleep. 2005 ; Vol. 28, No. 9. pp. 1122-1130.
@article{0323913f0a894f39b91e152a210a910c,
title = "Polysomnographic predictors of blood pressure and hypertension: Is one index best?",
abstract = "Study Objectives: Numerous indexes derived from polysomnography are available to characterize sleep-disordered breathing, with no consensus over which measures best predict clinical outcomes. This study addresses the relative merits of using alternative polysomnography indexes by characterizing the consistency and strength of the association of each index with blood pressure and hypertension. Design: Cross-sectional analyses of the association of alternative polysomnography indexes with blood pressure and hypertension were performed in construction and validation data sets. Linear and logistic regression models were used to identify the best variable sets. Patients: Data were obtained from 6433 men and women (age 62.9 ± 11.0 years, 52.8{\%} women) who participated in the Sleep Heart Health Study. Results: In multivariable models, most indexes showed weak linear associations with systolic, with slightly stronger associations for diastolic blood pressure, and the log odds of hypertension. No single index showed consistent superiority over others. Systolic blood pressure, diastolic blood pressure, and hypertension each were associated with distinct sets of polysomnography variables. Slightly more-consistent associations were demonstrated for indexes that included hypopneas that were linked with either a 3{\%} or 4{\%} desaturation level than indexes that did not require hypopneas to have linked desaturation. For indexes that combined apneas and hypopneas, there was no evidence that linking obstructive apneas to desaturation or arousal altered prediction compared with counting all apneas. Conclusion: In summary, using a rigorous cross-validation assessment, we did not identify a clear superiority of any single index for blood pressure or hypertension prediction. Detailed analyses of alternative definitions of the respiratory disturbance index support current scoring guidelines, where desaturation criteria are recommended for hypopneas but not apneas.",
keywords = "Blood pressure, Hypertension, Scoring, Sleep apnea",
author = "Susan Redline and Min, {Nancy I.} and Eyal Shahar and David Rapoport and George O'Connor",
year = "2005",
month = "9",
day = "1",
language = "English (US)",
volume = "28",
pages = "1122--1130",
journal = "Sleep",
issn = "0161-8105",
publisher = "American Academy of Sleep Medicine",
number = "9",

}

TY - JOUR

T1 - Polysomnographic predictors of blood pressure and hypertension

T2 - Is one index best?

AU - Redline, Susan

AU - Min, Nancy I.

AU - Shahar, Eyal

AU - Rapoport, David

AU - O'Connor, George

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Study Objectives: Numerous indexes derived from polysomnography are available to characterize sleep-disordered breathing, with no consensus over which measures best predict clinical outcomes. This study addresses the relative merits of using alternative polysomnography indexes by characterizing the consistency and strength of the association of each index with blood pressure and hypertension. Design: Cross-sectional analyses of the association of alternative polysomnography indexes with blood pressure and hypertension were performed in construction and validation data sets. Linear and logistic regression models were used to identify the best variable sets. Patients: Data were obtained from 6433 men and women (age 62.9 ± 11.0 years, 52.8% women) who participated in the Sleep Heart Health Study. Results: In multivariable models, most indexes showed weak linear associations with systolic, with slightly stronger associations for diastolic blood pressure, and the log odds of hypertension. No single index showed consistent superiority over others. Systolic blood pressure, diastolic blood pressure, and hypertension each were associated with distinct sets of polysomnography variables. Slightly more-consistent associations were demonstrated for indexes that included hypopneas that were linked with either a 3% or 4% desaturation level than indexes that did not require hypopneas to have linked desaturation. For indexes that combined apneas and hypopneas, there was no evidence that linking obstructive apneas to desaturation or arousal altered prediction compared with counting all apneas. Conclusion: In summary, using a rigorous cross-validation assessment, we did not identify a clear superiority of any single index for blood pressure or hypertension prediction. Detailed analyses of alternative definitions of the respiratory disturbance index support current scoring guidelines, where desaturation criteria are recommended for hypopneas but not apneas.

AB - Study Objectives: Numerous indexes derived from polysomnography are available to characterize sleep-disordered breathing, with no consensus over which measures best predict clinical outcomes. This study addresses the relative merits of using alternative polysomnography indexes by characterizing the consistency and strength of the association of each index with blood pressure and hypertension. Design: Cross-sectional analyses of the association of alternative polysomnography indexes with blood pressure and hypertension were performed in construction and validation data sets. Linear and logistic regression models were used to identify the best variable sets. Patients: Data were obtained from 6433 men and women (age 62.9 ± 11.0 years, 52.8% women) who participated in the Sleep Heart Health Study. Results: In multivariable models, most indexes showed weak linear associations with systolic, with slightly stronger associations for diastolic blood pressure, and the log odds of hypertension. No single index showed consistent superiority over others. Systolic blood pressure, diastolic blood pressure, and hypertension each were associated with distinct sets of polysomnography variables. Slightly more-consistent associations were demonstrated for indexes that included hypopneas that were linked with either a 3% or 4% desaturation level than indexes that did not require hypopneas to have linked desaturation. For indexes that combined apneas and hypopneas, there was no evidence that linking obstructive apneas to desaturation or arousal altered prediction compared with counting all apneas. Conclusion: In summary, using a rigorous cross-validation assessment, we did not identify a clear superiority of any single index for blood pressure or hypertension prediction. Detailed analyses of alternative definitions of the respiratory disturbance index support current scoring guidelines, where desaturation criteria are recommended for hypopneas but not apneas.

KW - Blood pressure

KW - Hypertension

KW - Scoring

KW - Sleep apnea

UR - http://www.scopus.com/inward/record.url?scp=24644459724&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24644459724&partnerID=8YFLogxK

M3 - Article

C2 - 16268382

AN - SCOPUS:24644459724

VL - 28

SP - 1122

EP - 1130

JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 9

ER -