Sleep apnea, snoring can increase risk of CAD, hypertension; Relationships influenced by BMI

Possibly driven in part by BMI, snoring and sleep apnea were associated with increased risk for hypertension and CAD, according to a Mendelian randomization analysis.

“Our results suggest that sleep apnea and snoring increase the risk of hypertension and CAD, but these associations may be partially driven by BMI. [Losing weight] The guidelines have strong recommendations for sleep apnea management. However, with low-quality evidence, ” live WangPhD, School of Public Health, Sun Yat-sen University, Guangzhou, China, and colleagues wrote. “Our findings confirm that BMI plays an important role in the association of sleep apnea with CVD.”

The investigators conducted a two-sample bidirectional Mendelian randomization study to assess the association, including the possibility of causality, between sleep apnea/snoring and CVD. The cohort consisted of 523,366 participants, of whom 25,008 had a single nucleotide polymorphism associated with sleep apnea and 172,050 had a single nucleotide polymorphism associated with snoring.

CVD outcomes were hypertension, atrial fibrillation, CAD, stroke and HF.

The researchers found that genetically predisposed snoring was positively associated with hypertension risk (OR = 1.05; 95% CI, 1.03-1.07; P = .00008) and CAD (OR = 1.61; 1.26-2.07, P = .00078), but the association was no longer significant after adjustment for BMI.

Similarly, genetically predicted sleep apnea was associated with increased risk of hypertension (OR = 1.03; 95% CI, 1.02-1.05) and CAD (OR = 1.41; 95% CI, 1.19-1.67), but the association was reduced after adjustment for BMI. . .

According to the researchers, sleep apnea and snoring were not associated with increased risk of AF, HF or stroke.
High blood pressure was associated with a higher risk for sleep apnea (OR = 1.53; 95% CI, 1.04-2.25), but the false discovery rate was greater than .05, the researchers wrote.

Wang and colleagues wrote that this is the first bidirectional Mendelian randomization study to show an effect of snoring and sleep apnea on multiple CVD outcomes.

“Excessive stimulation leads to sympathetic activation and parasympathetic withdrawal, which can lead to elevated blood pressure and heart rate. Rapid increases in preload and afterload associated with large intrathoracic pressure swings can promote systemic hypertension,” wrote Wang and colleagues. “Meanwhile, hypertension can be both a cause and a consequence of obstructive sleep apnea because hypertension can affect genioglossus activity and decrease upper airway tone. Therefore, intensive hypertension control may be beneficial for people with severe sleep apnea.”