Sleep apnea, snoring may increase CAD, hypertension risk; relationship influenced by BMI
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Possibly driven partly by BMI, snoring and sleep apnea were associated with increased risk for hypertension and CAD, according to a Mendelian randomization analysis.
“Our results suggested sleep apnea and snoring increased the risk of hypertension and CAD, but these associations may partly be driven by BMI. [Losing weight] has been a strong recommendation for sleep apnea management in guidelines. However, with low-quality evidence,” Jiao Wang, PhD, from the School of Public Health, Sun Yat-sen University, Guangzhou, China, and colleagues wrote. “Our finding confirmed that BMI plays an essential role in the association of sleep apnea with CVD.”
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The researchers conducted a two-sample bidirectional Mendelian randomization study to assess the relationship, including the potential for causality, between sleep apnea/snoring and CVD. The cohort included 523,366 participants, of whom 25,008 had a single nucleotide polymorphism associated with sleep apnea and 172,050 had a single nucleotide polymorphism associated with snoring.
The CVD outcomes were hypertension, atrial fibrillation, CAD, stroke and HF.
The researchers found that genetically predicted snoring was positively associated with risk for hypertension (OR = 1.05; 95% CI, 1.03-1.07; P = .00008) and CAD (OR = 1.61; 1.26-2.07, P = .00078), but the association was no longer significant after adjusting for BMI.
Similarly, genetically predicted sleep apnea was associated with risk for hypertension (OR = 1.03; 95% CI, 1.02-1.05) and CAD (OR = 1.41; 95% CI, 1.19-1.67), but the association was attenuated after adjustment for BMI.
Sleep apnea and snoring were not associated with risk for AF, HF or stroke, according to the researchers.
Hypertension was associated with elevated risk for sleep apnea (OR = 1.53; 95% CI, 1.04-2.25), but the false discovery rate was greater than .05, the researchers wrote.
Wang and colleagues wrote that this is the first bidirectional Mendelian randomization study to show the effect of snoring and sleep apnea in multiple CVD outcomes.
“Excessive arousals cause sympathetic activation and parasympathetic withdrawal, which may cause higher blood pressure and heart rate. The acute increases in preload and afterload related to large intrathoracic pressure swings might exacerbate the systemic hypertension,” Wang and colleagues wrote. “Meanwhile, hypertension may be a cause and consequence of obstructive sleep apnea since higher blood pressure might influence genioglossus activity and lead to decrements in upper airway tone. Therefore, intensive hypertension control may be beneficial for individuals with severe sleep apnea.”
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