Obstructive Sleep Apnea Diagnosis and Management in Hypertensive Patients

Clinical Indications for Sleep Study

• The European Society of Cardiology recommends that obstructive sleep apnea (OSA) should be suspected in all patients with hypertension, especially when other secondary causes have been excluded 1, 2
• OSA is particularly common in resistant hypertension, with studies indicating up to 60% of patients with resistant hypertension have features of OSA 1
• Patient presents with hypertension at a young age with secondary causes ruled out except OSA 1

Relevant Clinical Features

• Young female with hypertension, which is unusual and suggests a secondary cause 1
• OSA in women is often associated with hypothyroidism, which should be considered in the differential diagnosis 2
• Non-dipping or reverse-dipping pattern on 24-hour blood pressure monitoring may be present in patients with OSA, if available 1

Recommended Testing

• Overnight polysomnography (PSG) is the gold standard diagnostic test for OSA, according to the European Heart Journal and the Journal of the American Geriatrics Society 1, 2
• The apnea-hypopnea index (AHI) will determine OSA severity, with mild defined as AHI < 15, moderate as AHI 15-30, and severe as AHI > 30 1