Sleep-Disordered Breathing and Prevalent Hypertension in Men with and Without HIV

Naresh M. Punjabi; Todd T. Brown; Alexandre R. Abreu; Rashmi Nisha Aurora; Sanjay R. Patel; Valentina Stosor; Joshua Hyong Jin Cho; Gypsyamber D'Souza; Douglas Wallace; Joseph B. Margolick

doi:10.1097/QAI.0000000000003276

Sleep-Disordered Breathing and Prevalent Hypertension in Men with and Without HIV

Naresh M. Punjabi^*, Todd T. Brown, Alexandre R. Abreu, Rashmi Nisha Aurora, Sanjay R. Patel, Valentina Stosor, Joshua Hyong Jin Cho, Gypsyamber D'Souza, Douglas Wallace, Joseph B. Margolick

^*Corresponding author for this work

Medicine, Infectious Diseases Division

Research output: Contribution to journal › Article › peer-review

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Abstract

Background:Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension.Setting:The Multicenter AIDS Cohort Study.Methods:SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI_3a) and ≥4% (AHI₄) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression.Results:The prevalence of hypertension and SDB (AHI_3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI_3a, AHI₄, ODI₃, and ODI₄).Conclusions:Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.

Original language	English (US)
Pages (from-to)	349-354
Number of pages	6
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	94
Issue number	4
DOIs	https://doi.org/10.1097/QAI.0000000000003276
State	Published - Dec 1 2023

Funding

The MACS/WIHS Combined Cohort Study (MWCCS) was supported by the following Grants: Baltimore CRS (T.T.B. and J.B.M.), U01-HL146201; Data Analysis and Coordination Center (G.D.’S., Stephen Gange, and Elizabeth Topper), U01-HL146193; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo). The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional cofunding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders and Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR003098 (JHU ICTR) and UL1-TR001881 (UCLA CTSI).

Keywords

HIV
hypertension
sleep apnea
sleep-disordered breathing

ASJC Scopus subject areas

Infectious Diseases
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QAI.0000000000003276

Cite this

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title = "Sleep-Disordered Breathing and Prevalent Hypertension in Men with and Without HIV",

abstract = "Background:Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension.Setting:The Multicenter AIDS Cohort Study.Methods:SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI3a) and ≥4% (AHI4) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression.Results:The prevalence of hypertension and SDB (AHI3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI3a, AHI4, ODI3, and ODI4).Conclusions:Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.",

keywords = "HIV, hypertension, sleep apnea, sleep-disordered breathing",

author = "Punjabi, {Naresh M.} and Brown, {Todd T.} and Abreu, {Alexandre R.} and Aurora, {Rashmi Nisha} and Patel, {Sanjay R.} and Valentina Stosor and Cho, {Joshua Hyong Jin} and Gypsyamber D'Souza and Douglas Wallace and Margolick, {Joseph B.}",

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doi = "10.1097/QAI.0000000000003276",

language = "English (US)",

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pages = "349--354",

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T1 - Sleep-Disordered Breathing and Prevalent Hypertension in Men with and Without HIV

AU - Punjabi, Naresh M.

AU - Brown, Todd T.

AU - Abreu, Alexandre R.

AU - Aurora, Rashmi Nisha

AU - Patel, Sanjay R.

AU - Stosor, Valentina

AU - Cho, Joshua Hyong Jin

AU - D'Souza, Gypsyamber

AU - Wallace, Douglas

AU - Margolick, Joseph B.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - Background:Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension.Setting:The Multicenter AIDS Cohort Study.Methods:SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI3a) and ≥4% (AHI4) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression.Results:The prevalence of hypertension and SDB (AHI3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI3a, AHI4, ODI3, and ODI4).Conclusions:Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.

AB - Background:Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension.Setting:The Multicenter AIDS Cohort Study.Methods:SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI3a) and ≥4% (AHI4) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression.Results:The prevalence of hypertension and SDB (AHI3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI3a, AHI4, ODI3, and ODI4).Conclusions:Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.

KW - HIV

KW - hypertension

KW - sleep apnea

KW - sleep-disordered breathing

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Sleep-Disordered Breathing and Prevalent Hypertension in Men with and Without HIV

Abstract

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UN SDGs

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