0985 Excessive Daytime Sleepiness and Prevalent and Incident Hypertension: The Modifying Effect of Objective Sleep Disturbance

Abstract Introduction Excessive daytime sleepiness (EDS) has been linked to adverse cardiovascular outcomes. In this study we examined whether the relationship between EDS and the risk of hypertension in a large random general population sample is modified by objective polysomnography derived markers of sleep disturbance. Methods Prevalent and incident hypertension was calculated from the 1741 adults of the Penn State Adult Cohort at baseline, and 786 subjects without hypertension who were followed-up for an average of 7.5 years respectively. EDS was defined based on a report of moderate-to-severe daytime sleepiness/drowsiness and/or irresistible sleep attacks at baseline or at follow-up. All subjects underwent 8-hour polysomnography. Prolonged sleep-onset latency (SL ≥30 minutes) during overnight polysomnography served as an index of sleep disturbance/hyperarousal. Prevalent hypertension was defined by systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or antihypertensive treatment. Incident hypertension was determined by diagnosis or self-reported antihypertensive treatment. We created four mutually exclusive groups: no EDS and SL< 30minutes as the reference group; no EDS and SL≥ 30 minutes; EDS and SL< 30 minutes; and EDS and SL≥30minutes. In logistic regression analysis we adjusted for sex, baseline age, BMI, race/ethnicity, smoking, caffeine use, alcohol use, diabetes, depression, apnea/hypopnea index, total sleep time, wake time after sleep onset, and sampling weight; in addition, longitudinal logistic regression models also adjusted for follow-up duration. Results Individuals reporting EDS demonstrated higher odds of both prevalent and incident hypertension compared with normal controls (OR:1.52; 95%CI:1.01-2.27; p=0.044; OR:1.74; 95%CI:1.05-2.87; p=0.030, respectively). The combination of EDS with objectively prolonged SL conferred a twofold increase in prevalent (OR:2.34; 95%CI:1.18-4.63; p=0.015) or incident hypertension (OR:3.43; 95%CI:1.58-7.41; p=0.002) compared to normal controls. Conclusion These findings indicate that prolonged SOL may represent a useful marker of a prevalent EDS subgroup, associated with hyperarousal. Recognizing this phenotype may lead to more accurate clinical diagnosis and targeted therapeutic approaches which is the goal of personalized medicine. Support (if any)