Sleep apnea hypertension

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

Poor sleep architecture and fragmented sleep secondary to OSA can cause excessive daytime sleepiness (EDS) and neu-rocognitive deficits. These sequelae can affect quality of life and work performance and may be linked to occupational and motor vehicle accidents. OSA is also associated with systemic disease such as hypertension, heart failure, and stroke.21-23 OSA is likely an independent risk factor for the development of hypertension.24 Further, when hypertension is present, it is often resistant to antihypertensive therapy. Fatal and non-fatal cardiovascular events are two- to threefold higher in male patients with severe OSA.25 OSA is associated with or aggravates biomarkers for cardiovascular disease, including C-reactive protein and leptin.26,27 Patients with sleep apnea often are obese and maybe predisposed to weight gain. Hence, obesity may further contribute to cardiovascular disease in this patient population. 

Typical complications include insomnia and excessive daytime sleepiness due to frequent nighttime awakenings. Sleep electroencephalogram (EEG) reveals absent or decreased slow-wave sleep, and, in some patients, early-onset REM sleep. If untreated, long-term effects of sleep apnea include increased incidence of hypertension vascular events (e.g., myocardial infarction, stroke) poor work performance increased risk of traffic accidents and stress in personal relationships ( 22, 23). 

Nieto FJ, Young TB, Link BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 2000 283 1829-1836. 

Hypogonadism can be accompanied by hot flushes, similar to those seen in postmenopausal women, and gynecomastia. The potential risks of testosterone replacement in adult men are precipitation or worsening of sleep apnea, hastened onset of clinical significant prostate disease, benign prostatic hyperplasia, prostatic carcinoma, gynecomastia, fluid retention, polycythemia, exacerbation of hypertension, edema, and an increased risk of cardiovascular disease. 

Lewis D, Chesson AL, Edwards MS, Weeks JW, Adair CD. Obstructive sleep apnea during pregnancy resulting in pulmonary hypertension. South Med J 1998 ... 

Finally, sleep disorders per se can have the same outcome on operator performance as sleep loss or alcohol intoxication. It does not make sense that commercial truck drivers must be screened for arterial hypertension but not for obstructive sleep apnea syndrome. The need for general screening of commercial and public operators for obstructive sleep apnea syndrome is highlighted by the fatal train accident in Clarkston, Michigan on November 15, 2001, in which the engineer s untreated and conductor s insufficiently treated sleep apnea were determined as the probable primary cause of the accident. 

Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J (1994) Sleep apnea and hypertension. A population-based study. Ann Intern Med 120 382-388... 

Heitmann J, Grote L, Knaack L, Kohler U, Hinder M, Peter JH (1998) Cardiovascular effects of mibefradil in hypertensive patients with obstructive sleep apnea. Eur J Clin Pharmacol 54 691-696... 

Gislason T, Benediktsdottir B, Bjornsson JK, Kjartansson G, Kjeld M, Kristbjarnarson H (1993) Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest 103 1147-1151... 

Scientists believe there is a causal link between sleep apnea and hypertension. Alleviating the disorder either by surgically removing... 

Several clinical and experimental studies have provided novel insights into the pathogenesis of lone AF, and modern diagnostic techniques have revealed previously unappreciated abnormalities. Thus in some patients with lone AF, there may be underlying abnormalities that are either occult or have yet to be discovered. In some patients with lone AF, occult hypertension may be present but masked by the antihypertensive effects of medications used for rate control. Several epidemiological associations of AF include obesity, sleep apnea, diabetes, metabolic syndrome, increased alcohol consumption, anger and hostility, increased pulse pressure, and subclinical atherosclerosis (assessed by carotid... 

In contrast, hypnotic doses of benzodiazepines may worsen sleep-related breathing disorders by adversely affecting control of the upper airway muscles or by decreasing the ventilatory response to CO2. The latter effect may cause hypoventilation and hypoxemia in some patients with severe COPD, although benzodiazepines may improve sleep and sleep structure in some instances. In patients with obstructive sleep apnea (OSA), hypnotic doses of benzodiazepines may exaggerate the impact of apneic episodes on alveolar hypoxia, pulmonary hypertension, and cardiac ventricular load. Caution should be exercised with patients who snore regularly partial airway obstruction may be converted to OSA under the influence of these drugs. 

In addition to diabetes, there are many health risks associated with obesity, ranging from metabolic disturbances such as hyperlipidemia, insuhn resistance, and hypertension, to sleep apnea, gallstones, arthritis, and an increased risk for several mahgnancies. These obesity-related medical problems are compounded by the social stigmata of obesity, depression, and the difficulties that obesity poses on the physical examination, diagnostic medical tests, and otherwise routine surgery. 

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