The Evaluation of Diastolic Hypertention in Sleep Overlap Syndrome

Document Type: Original Article


1 Pulmonologist, COPD Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pulmonologist, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Fellowship of Pulmonology, COPD Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction:The overlap syndrome, consisting ofobstructive sleep apnea hypopnea syndrome (OSAHS) and chronic obstructvie pulmonary disease (COPD) is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension.The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood presssure (DBP) in overlap  patients.
Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurment of resting diastolic blood pressure (DBP) in patients with overlap syndrome in Sleep Laboartory of Imam Reza Hospital, Mashhad, Iran from October 2011 to December 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index (AHI) (AHI <5, AHI :5-15, AHI :15-30 and AHI >30).Descriptive statistics included age, body mass index (BMI), OSA, Apnea-Hypopnea Index (AHI), DBP, and neck circumference.
Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups (80±0.50, 95±0.60, and 105±0.65, respectively) (p<0.001).Additionally, there was statistically significant correlation between AHI and DBP (r= 0.60, p=0.01).
Conclusion:According to the findings of our study, DBP is an imprtant cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI.



1. Sadock BJ, Sadock VA. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry.8th ed. New York: Lippincott Williams & Wilkins; 2004.

2. Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J. 2002;20:1594-1609.

3.  Lee-Chiong T. Sleep: A Comprehensive Handbook. 1st ed. New Jersey: John Wiley & Sons; 2005.

4. Bhullar  S, Phillips  B .Sleep in COPD patients . COPD: journal of Chronic Obstrucive Pulmonary Disease 2005 ; 2 : 355-361.  

5. Amra B, Farajzadegan Z, Golshan M, Fietze I, Penzel T. Prevalence of sleep apnea-related symptoms in a Persian population. Sleep Breath. 2011;15:425-9.

6. Young T, Palta M, Dempsey J, Skatrus J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328: 1230–5.

7. Halbert RJ, Isonaka S, George D, et al. Interpreting COPD prevalence estimates.What is the true burden of disease?. Chest. 2003;123: 1684–92.

9.Mapel D W, Dedrick  D, Kourtney  D .Trends and cardivascular co-morbidities of COPD patients in the Veterans administration medical system . COPD. 2005 Mar;2(1):35-41.

10.Gus M, Goncalves SC, Martinez D, de Abreu Silva EO, Moreira LB, Fuchs SC, et al. Risk for obstructive sleep apnea by Berlin questionnaire, but not daytime sleepiness, is associated with resistant hypertension: a case-control study. Am J Hypertens. 2008; 21: 832 – 835.

16. Nieto FJYoung TBLind BKShahar ESamet JMRedline SD'Agostino RBNewman ABLebowitz MDPickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000 Apr 12;283:1829-36

17. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: updated: 2013. Global Initiative for Chronic Obstructive Lung Disease (GOLD).

18. Pronzato C. Chronic obstructive pulmonary disease and obstructive sleep apnea.Association, consequences and treatment. Monaldi Arch Chest Dis. 2010 ;73:155-61.

19.  Li JRChen XSun JJ. Relationship between obstructive sleep apnea-hypopnea syndrome and hypertension. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012;47:97-100.

 20. Guillot MSforza EAchour-Crawford EMaudoux DSaint-Martin MBarthélémy JCRoche F. Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population. Sleep Med. 2013;14:838-42

21.Lee YJJeong DU. Obstructive sleep apnea syndrome is associated with higher diastolic blood pressure in men but not in women. Am J Hypertens 2014;27:325-30.