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Terry Young, PhD; Paul Peppard, MS; Mari Palta, PhD; K. Mae Hla, MD; Laurel Finn, MS; Barbara Morgan, PhD; James Skatrud, MD

Arch Intern Med. 1997;157(15):1746-1752.

Abstract
Background
Clinical observations have linked sleepdisordered breathing, a condition of repeated apneas and hypopneas during sleep, with hypertension but evidence for an independent association has been lacking. Understanding this relationship is important because the prevalence of sleep-disordered breathing is high in adults.

Objective
To test the hypothesis that sleep-disordered breathing is related to elevated blood pressure independent of confounding factors.

Methods
The sample included 1060 employed women and men aged 30 through 60 years who had completed an overnight protocol as part of the Wisconsin Sleep Cohort Study. In-laboratory polysomnography was used to determine sleep-disordered breathing status, quantified as the number of apneas and hypopneas per hour of sleep (apnea-hypopnea index). Blood pressure was measured on the night polysomnography was performed.

Results
Blood pressure increased linearly with increasing apnea-hypopnea index (P=.003 for systolic, P=.01 for diastolic, adjusted for confounding factors). The magnitude of the linear association increased with decreasing obesity. At a body mass index (weight in kilograms divided by the square of the height in meters) of 30 kg/m2, an apnea-hypopnea index of 15 (vs 0) was associated with blood pressure increases of 3.6 mm Hg for systolic (95% confidence interval, 1.3-6.0) and 1.8 mm Hg for diastolic (95% confidence interval, 0.3-3.3). The odds ratio for hypertension associated with an apneahypopnea index of 15 (vs 0) was 1.8 (95% confidence interval, 1.3-2.4).

Conclusions
There is a dose-response relationship between sleep-disordered breathing and blood pressure, independent of known confounding factors. If causal, the high prevalence of sleep-disordered breathing could account for hypertension in a substantial number of adults in the United States.

Arch Intern Med. 1997;157:1746-1752

Author Affiliations
From the Departments of Preventive Medicine (Drs Young and Palta and Mr Peppard and Ms Finn), Medicine (Drs Hla and Skatrud), and Kinesiology (Dr Morgan), University of Wisconsin, Madison.

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