Sleep determinants of incident hypertension in a population-based cohort: the CoLaus/HypnoLaus study

Aims and objectives: To analyze the sleep determinants of incident hypertension (HT) in a population-based cohort. Methods: CoLaus is a prospective population-based cohort in which cardiovascular profile was assessed at baseline and 2 subsequent follow-ups. HT was defined as systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or anti-HT drug use. HypnoLaus study analyzed sleep characteristics in a subset of CoLaus population at the first follow-up. All HypnoLaus participants underwent a full polysomnography (PSG) at home. The autonomic activation during sleep was assessed using pulse wave amplitude (PWA) drops based on the photoplethysomnographic signal of the PSG. Results: Of the 1,304 participants (49.1±9.6 years, 56% women) without HT at baseline, 338 developed HT between baseline and the second follow-up (10.8±0.1 years interval). After adjustment for age, sex, body mass index (BMI), delta BMI (between baseline and PSG/first follow-up) as well as SBP and DBP at baseline, the following sleep parameters were independently associated with incident HT: PWA drops duration (OR for each 1s: 1.10 [1.04-1.16], p=0.001), apnea-hypopnea index in REM sleep (REM-AHI) (OR: 1.02 [1.01-1.03], p=0.001), and percentage of time spent with an oxygen saturation <90% (OR for each 1%: 1.01 [1.00-1.03], p=0.042). In a stepwise multivariate logistic regression including all significant parameters in bivariate analysis, PWA drop duration (p=0.0001) and REM-AHI (p=0.003) were independently associated with incident HT. Conclusions: Nocturnal autonomic activation and REM-AHI seem to contribute to incident HT in the middle-to-older-age CoLaus/HypnoLaus cohort.