The Association Between Obstructive Sleep Apnea and Systemic Hypertension: A Review of Epidemiological and Pathophysiological Evidence

Abstract

Introduction: Systemic hypertension is a primary risk factor for cardiovascular disease, and the identification of modifiable secondary causes is a clinical priority. Obstructive Sleep Apnea (OSA), a highly prevalent disorder of intermittent airway collapse during sleep, has emerged as a major independent contributor to elevated blood pressure.

Literature Review: A review of pivotal literature establishes a strong, independent, and dose-response relationship between OSA severity and the prevalence and incidence of hypertension. Large, population-based cohort studies provided robust epidemiological evidence for this association. The pathophysiological pathways linking OSA to hypertension were elucidated, with key mechanisms including chronic daytime overactivity of the sympathetic nervous system, endothelial dysfunction driven by intermittent hypoxia and oxidative stress, and activation of the renin-angiotensin-aldosterone system. Furthermore, randomized controlled trials demonstrated that treating OSA with Continuous Positive Airway Pressure (CPAP) therapy results in a modest but clinically significant reduction in blood pressure, providing causal support for the relationship.

Conclusion: The body of evidence reviewed firmly establishes OSA as a causal factor in the development and maintenance of systemic hypertension. This understanding has led to the widespread recognition of OSA as a common cause of secondary and treatment-resistant hypertension, making screening for this sleep disorder an integral part of modern hypertension management.