Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care—Associations with sleep complaints, depressive symptoms and global perceived health

Anders Broström, Ola Sunnergren, Kristofer Årestedt, Peter Johansson, Per Nilsen, Bengt Fridlund, Eva Svanborg

Department of Cardiology, Link?ping University Hospital, Link?ping, Sweden..
Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Link?ping University, Link?ping, Sweden.
Department of Nursing Science, School of Health Sciences, J?nk?ping University, J?nk?ping, Sweden.
Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Link?ping University, Link?ping, Sweden.
School of Health and Caring Sciences, Faculty of Health, Social Work and Behavioural Sciences, Linnaeus University, Kalmar, Sweden.

DOI: 10.4236/ojn.2013.36060                

Abstract

Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.

Keywords

Depression; Global Perceived Health; Hypertension; Nursing Care; Obstructive Sleep Apnea; Sleep Disordered Breathing; Sleep

Conflicts of Interest

The authors declare no conflicts of interest.

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