Resistant hypertension and obstructive sleep apnea in the setting of kidney disease

J Hypertens. 2012 May;30(5):960-966. doi: 10.1097/HJH.0b013e328351d08a.


Objectives: To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Methods: We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90 mmHg despite at least three antihypertensive drugs.

Results: Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2 mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix.

Conclusion: The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / pharmacology
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory / methods
  • Case-Control Studies
  • Drug Resistance
  • Female
  • Humans
  • Hypertension / complications*
  • Hypertension / diagnosis
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / diagnosis
  • Male
  • Middle Aged
  • Polysomnography / methods
  • Sleep
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / diagnosis


  • Antihypertensive Agents