Oxygen desaturation rate as a novel intermittent hypoxemia parameter in severe obstructive sleep apnea is strongly associated with hypertension

Abstract

Study objectives: To investigate the effects of different intermittent hypoxemia properties on blood pressure (BP) and short-term blood pressure variability (BPV) in severe obstructive sleep apnea (OSA) patients.

Methods: Nocturnal BP was continuously monitored by measuring pulse transmit time. Apnea-related systolic BP elevation values were used to reflect BPV. Beat-to-beat R-R interval data were incorporated in polysomnography for heart rate variability analysis. The low-frequency/high-frequency band ratio was used to reflect sympathovagal balance. The rate of pulse oxyhemoglobin saturation (SpO₂) decrease was counted as the change in the percentage of SpO₂ per second after obstructive apnea and expressed as the oxygen desaturation rate (ODR). Patients with severe OSA (n = 102) were divided into 2 groups according to the median ODR: faster ODR (FODR group: ODR > 0.37, n = 50) and slower ODR (ODR ≤ 0.37, n = 52).

Results: Comparisons between the 2 groups showed significantly higher systolic BP (SBP) values in the FODR group than in the slower ODR group (awake SBP 149.9 ± 18.3 vs 131.8 ± 15.6 mm Hg; asleep SBP: 149.6 ± 19.9 vs 128.7 ± 15.6 mm Hg; both P < .001), as well as short-term BPV (15.0 ± 4.8 vs 11.6 ± 3.6 mm Hg; P < .001), and the prevalence of hypertension (74.0% vs 26.9%; P < .001). Multiple linear regression analyses revealed that after adjusting for body mass index, functional residual capacity, expiratory reserve volume, and baseline SpO2, ODR, as assessed by ΔSpO₂/Δt, had the strongest association with both BP and short-term BPV. Correlation analysis showed that ODR was positively correlated with the low-frequency/high-frequency band ratio (r = .288, P = .003).

Conclusions: ODR, as a novel hypoxemia profile, was more closely associated with the elevation of BP and BPV in patients with severe OSA. FODR might be associated with enhanced sympathetic activity.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Characteristics of Obstructive Sleep Apnea Syndrome Related Hypertension and the Effect of Continuous Positive Airway Pressure Treatment on Blood Pressure; URL: https://ichgcp.net/clinical-trials-registry/NCT03246022; Identifier: NCT03246022.

Keywords: blood pressure variability; hypertension; intermittent hypoxemia; obstructive sleep apnea; oxygen desaturation rate.

Conflict of interest statement

All authors have seen and approved the manuscript. This work was funded by the National Natural Science Foundation of China (81900084).

© 2020 American Academy of Sleep Medicine.

Figures

Figure 1. Correlation of ODR with BP and short-term BPV.

Correlation with BP (A,B) and short-term BPV (C). BP = blood pressure, BPV = blood pressure variability, ODR = oxygen desaturation rate, SpO2 = pulse oxyhemoglobin saturation.

Figure 2. Correlation analysis for relationship of ODR with LF/HF band ratio, BMI, and lung volume.

Correlation with LF/HF band ratio (A), BMI (B), and lung volume (C,D). BMI, body mass index, LF/HF = low-frequency/high-frequency, ODR = oxygen desaturation rate, SpO2 = pulse oxyhemoglobin saturation.