Resistant Hypertension in Chronic Kidney Disease

201

5

1.0

1.5

2.0

2.5

3.0

3.5

10 15 20 30 40 50

Apnoea-hypopnoea index

Odds ratio

Odds ratios

Wald 95% confidence intervals

60 70

Fig. 13.2 Incidence of hypertension over time in patients without OSA and untreated patients
with OSA of varying severities. Severity of OSA was defined by the apnea-hypopnea index (AHI)
as mild OSA (AHI 5.0–14.9), moderate OSA (AHI 15.0–29.9), and severe OSA (AHI ≥ 30) (From
Lavie et al. [ 14 ]; with permission)

Recurrent episodes of airway obstruction during sleep

Intermittent hypoxia/Sleep fragmentation

Hypercapnia

Chemoreflex activation

autonomic CV modulation

RAAS activity

Aldosterone

Sympathetic

activation

ROS, ET-1,

NOS blockade

Vascular tone hypertensive peak followingsudden recovery

of LV function

OSAs-related

myocardial damage

arterial stiffness, LVH

office BP and 24th, day and night-time ambulatory BP levels

Non dipping pattern of BP, nocturnal hypertension

Fluid retention

NO production

vasodilatation

Inflammation

Oxidative stress

Endothelial

dysfunction

Dysglycemia;insulin

and leptin resistance

Alterations in LV

mechanical properties

changes in pulmonary volume

intrathoracic pressures

Fig. 13.3 Mechanisms by which obstructive sleep apnea syndrome (OSAS) may contribute to
resistant hypertension (From Parati et al. [ 35 ]; with permission)

13 Obstructive Sleep Apnea and Resistant Hypertension