Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex

OBJECTIVES: Obstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males. DESIGN: Retrospective analysis of electronic health records (EHR) over 10 years (2006–2015 inclusive). SETTING: University of California Los Angeles (UCLA) Health System in Los Angeles, California, USA. PARTICIPANTS: 4848 patients: females n=2086, mean (SD) age=52.8 (13.2) years; males n=2762, age=53.8 (13.5) years. These patients were selected from 1.6 million with diagnoses in the EHR who met these criteria: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least 1 year prior and 1 year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (OSA to HTN days). Since HTN and OSA are progressive disorders, a secondary measure was the relationship between OSA to HTN time and age (OSA to HTN=β(1)×Age+β(0)). RESULTS: The median (lower and upper quartiles) days from OSA to HTN were: all −532 (−1439, –3); females −610 (−1579, –42); and males −451 (−1358, 0). Older age in both sexes was associated with less time to a subsequent HTN diagnosis or more time from a prior HTN diagnosis (β(1) days/year: all −16.9, females −18.3, males −15.9). CONCLUSIONS: HTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings are consistent with underscreening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN.