Obstructive sleep apnea syndrome (OSAS) related hypertension: A review of pathophysiology and potential therapeutic approaches



Obstructive Sleep Apnea Syndrome, Hypertension, CPAP, Upper airway surgery


Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder related with cardiovascular diseases, including hypertension. There are lots of evidence supporting the relationship between OSAS and hypertension, modulated by multiple factors, but the exact mechanisms underlying this complex cause and effect relationship remain unclear. The alternating pattern of OSAS-related hypertension is closely related with target organ damage, especially in the heart and brain. In this review, the etiological factors, clinical types, probable pathophysiologic mechanisms, diagnostic methods, and current therapeutic approaches to OSAS-related hypertension is discussed in the light of current literature.


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Zhang W, Si L. Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches. Upsala Journal of Medical Sciences. 2012;117(4):370-82.

Csiszeriren I, Albu S, Neagos CM, Navadarszki M, Neagos A. The role of ultrasound in the diagnosis of obstructive sleep apnea. Romanian Journal of Rhinology. 2018;8(30):98-101.

Xu Z, Wu Y, Tai J, Feng G, Ge W, Zheng L, et al. Risk factors of obstructive sleep apnea syndrome in children. Journal of Otolaryngology-Head & Neck Surgery. 2020;49(11):2-7.

Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5:136–43.

Resuli AS. Cardiovascular Complications in Obstructive Apnea Syndrome. Multidiscip Cardio Annal. 2019; 10(1): 3-6. doi: 10.5812/mca.91534.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-5.

Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485-91.

Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523-38.

Kapur V, Strohl KP, Redline S, Iber C, O'Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in US communities. Sleep Breath. 2002;6:49-54.

Ryan S, McNicholas WT. Intermittent hypoxia and activation of inflammatory molecular pathways in OSAS. Archives of Physiology and Biochemistry. 2008;114(4):261-6.

Doonan RJ, Scheffler P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME, et al. Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res. 2011;34:23–32.

Lombardi C, Tobaldini E, Montano N, Losurdo A, Parati G. Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System. La Medicina del Lavoro. 2017;108(4):276-82.

Lattanzi S, Brigo F, Silvestrini M. Obstructive sleep apnea syndrome and the nocturnal blood pressure profile. Journal of Clinical Hypertension. 2018;20(6):1036-8.

Calhoun DA. Obstructive sleep apnea and hypertension. Curr Hypertens Rep. 2010;12:189-95.

Ahmad M, Makati D, Akbar S. Review of and Updates on Hypertension in Obstructive Sleep Apnea. International Journal of Hypertension. 2017; Article ID 1848375.

Noda A, Nakata S, Koike Y, Miyata S, Kitaichi K, Nishizawa T, et al. Continuous positive airway pressure improves daytime baroreflex sensitivity and nitric oxide production in patients with moderate to severe obstructive sleep apnea syndrome. Hypertens Res. 2007;30:669–76.

Troncoso Brindeiro CM, da Silva AQ, Allahdadi KJ, Youngblood V, Kanagy NL. Reactive oxygen species contribute to sleep apnea-induced hypertension in rats. Am J Physiol Heart Circ Physiol. 2007;293:2971-6.

Li NF, Yao XG, Zhu J, Yang J, Lin KJ, Wang YC, et al. Higher Levels of Plasma TNF-α and Neuropeptide Y in Hypertensive Patients with Obstructive Sleep Apnea Syndrome. Journal of Clinical and Experimental Hypertension. 2010;32:54-60.

Jeong Song Y, Kwon JH, Kim JY, Kim BY, Cho KI. The platelet-to-lymphocyte ratio reflects the severity of obstructive sleep apnea syndrome and concurrent hypertension. Clinical Hypertension. 2015;22:1-8.

Hanly PJ, Ahmed S, Fjell CD, Handley GB, Sola D, Nicholl D, et al. Urine biomarkers of renal renin–angiotensin system activity: Exploratory analysis in humans with and without obstructive sleep apnea. Physiological Reports. 2020;8:e14376.

Zalucky AA, Nicholl DDM, Hanly PJ, Poulin MJ, Turin TC, Walji S, et al. Nocturnal Hypoxemia Severity and Renin–Angiotensin System Activity in Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2015;192:873-80.

Kario K. Nocturnal Hypertension: New Technology and Evidence. Hypertension. 2018;71:997-1009.

Whelton PK, Carey RM, Aronow WS, De Casey JR, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/ AHA/ AAPA/ ABC/ ACPM/ AGS/ APhA/ ASH/ ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:113-5.

Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens. 2009;23(10):645-53.

Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure: Factors associated with lack of blood pressure control in the community. Hypertension. 2000;36(4):594–9.

Pedrosa RP, Drager LF, de Paula LKG, Amaro ACS, Bortolotto LA, Lorenzi-FilhoG. Effects of OSA Treatment on BP in Patients With Resistant Hypertension: A Randomized Trial. Chest. 2013;144:1487-94.

Baguet JP, Lévy P, Barone-Rochette G, Tamisier R, Pierre H, Peeters M, et al. Masked hypertension in obstructive sleep apnea syndrome. Journal of Hypertension. 2008;26:885-92.

Wong HS, Williams AJ, Mok YJ. The relationship between pulmonary hypertension and obstructive sleep apnea. Sleep and Respiratory Biology. 2017;23:517-21.

Niijima M, Kimura H, Edo H, Shinozaki T, Kang J, Masuyama S, et al. Manifestation of Pulmonary Hypertension During REM Sleep in Obstructive Sleep Apnea Syndrome. Am J. Respir Crit Care Med. 1999;159:1766-72.

Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med. 1996; 154:279-89.

Barvaux VA, Aubert G, Rodenstein DO. Weight loss as a treatment for obstructive sleep apnoea. Sleep Med Rev. 2000;4(5):435-52.

Deleanu OC, Pocora D, Mihalcuta S, Ulmeanu R, Zaharie AM, Mihaltan FD. Influence of smoking on sleep and obstructive sleep apnea syndrome. Pneumologia. 2016;65(1):28-35.

Tsutsumi W, Miyazaki S, Itasaka Y, Togawa K. Influence of alcohol on respiratory disturbance during sleep. Psychiatry Clin Neurosci. 2000;54:332-3.

Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, et al. A study to estimate prevalence and risk factors of Obstructive Sleep Apnea Syndrome in a semi-urban Indian population. Monaldi Archives for Chest Disease. 2017;87:40-8.

Won CHJ, Li KK, Guilleminault C. Surgical Treatment of Obstructive Sleep Apnea. Proc Am Thorac Soc. 2008;5:193-9.

Chaudhry F, Fashner J. Does CPAP treatment improve blood pressure in patients with obstructive sleep apnea and hypertension? Evidence-based Practice. 2020; ahead of print.

Ciccone MM, Favale S, Scicchitano P, Mangini F, Mitacchione G, Gadaleta F, et al. Reversibility of the endothelial dysfunction after CPAP therapy in OSAS patients. International Journal of Cardiology. 2012;158:383–6.

Kario K. Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control. Hypertension Research. 2009;32:537-41.

Samuelson JC, Morrow LE, Malesker MA. Surgical Procedures for Obstructive Sleep Apnea. US Pharm. 2018;43(1):2-7.

Mitchel RB. Adenotonsillectomy for Obstructive Sleep Apnea in Children: Outcome Evaluated by Pre‐ and Postoperative Polysomnography. Laryngoscope. 2007;117:1844-54.

Riley RW, Powell NB, Li KK, Troell RJ, Guilleminault C. Surgery and obstructive sleep apnea: long-term clinical outcomes. Otolaryngol Head Neck Surg. 2000;122:415-421.

Resuli AS. The Results of Surgical Treatment of Hypertension in Mild and Moderate Obstructive Sleep Apnea Syndrome. Multidiscip Cardio Annal. 2019;10(2): e91283. doi:10.5812/mca.91283.







How to Cite

Navdar A. Obstructive sleep apnea syndrome (OSAS) related hypertension: A review of pathophysiology and potential therapeutic approaches. J Surg Med [Internet]. 2020 May 1 [cited 2024 Jun. 23];4(5):410-3. Available from: https://jsurgmed.com/article/view/727915