The role of insomnia in the development of resistant hypertension in uncontrolled hypertensive patients with obstructive sleep apnea: A prospective study.

OBJECTIVES

To investigate the independent predictive value of insomnia for resistant hypertension (RH) in uncontrolled hypertensive patients with obstructive sleep apnea (OSA).

METHODS

This prospective follow-up study enrolled 386 OSA patients with uncontrolled blood pressure (BP) using 1 or 2 classes of antihypertensive drugs visiting Sleep Medicine Center from April 2021 to August 2022. Information on demographic characteristics, comorbidities, BP control and classes of antihypertensive medication, sleep related symptoms and sleep parameters was collected. Insomnia was assessed using DSM-V criteria and the Insomnia Severity Index (ISI). RH incidence according to the BP control and classes of antihypertensive drugs data during the 5 months follow-up was collected. Logistic regression models were used to assess the association between insomnia and RH, adjusting for potential confounders.

RESULTS

After 5 months follow-up, 301 participants were included for final data analysis. Insomnia was prevalent in 23.9 % of the participants and was associated with a higher risk of RH (adjusted ORs around 2.0, all P < 0.05). Participants with clinical insomnia (ISI >14) had a 4-6 times higher risk of RH compared to those without insomnia. Insomnia treatment improved ISI score significantly, but didn't reduce the incidence of RH significantly. Effective insomnia treatment was associated with antihypertensive drugs reduction (OR, 5.57; 95 % CI, 1.24-25.01).

CONCLUSIONS

Insomnia is an independent predictor of RH in uncontrolled hypertensive patients with OSA. Addressing insomnia may be crucial for managing RH in this patient population.