Risk of sleep apnea associated with higher blood pressure among Chinese and Korean Americans

ABSTRACT

Objective

This study examines associations between sleep apnea risk and hypertension in a sample of immigrant Chinese and Korean Americans.

Design

The dataset included Chinese and Korean patients ages 50–75 recruited from primary care physicians’ offices from April 2018 to June 2020 in the Baltimore-Washington DC Metropolitan Area (n = 394). Hypertension risk was determined using a combination of blood pressure measurements, self-reported diagnosis of hypertension by a medical professional, and/or self-reported use of antihypertensive medications. Linear regression models examined the associations between sleep apnea risk and blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Poisson regression models examined associations sleep apnea risk and hypertension. Models controlled for body mass index (BMI), demographic, and socioeconomic risk factors. We further examined models for potential effect modification by age, gender, Asian subgroup, and obesity, as well as effect modification of daytime sleepiness on the association between snoring and hypertension risk.

Results

High risk of sleep apnea appeared to be associated positively with SBP (β = 6.77, 95% CI: 0.00–13.53), but not with DBP. The association was positive for hypertension, but it was not statistically significant (PR = 1.11, 95% CI: 0.87–1.41). We did not find effect modification of the associations between sleep apnea and hypertension risk, but we did find that daytime sleepiness moderated the effect of snoring on SBP. Snoring was associated with higher SBP, primarily in the presence of daytime sleepiness, such that predicted SBP was 133.27 mmHg (95% CI: 126.52, 140.02) for someone with both snoring and daytime sleepiness, compared to 123.37 mmHg (95% CI: 120.40, 126.34) for someone neither snoring nor daytime sleepiness.

Conclusion

Chinese and Korean immigrants living in the U.S. who are at high risk of sleep apnea have higher SBP on average, even after accounting for sociodemographic characteristics and BMI.

Clinical Trail Registration

: NCT03481296, date of registration: 3/29/2018

KEYWORDS:

• Hypertension
• sleep apnea
• Asian Americans
• Chinese
• Korean
• immigrants

Sustainable Development Goals:

• SDG 3: Good health and well-being
• SDG 10: Reduced inequalities

Acknowledgements

The National Institute on Minority Health and Health Disparities of the National Institutes of Health provided financial support under award number R01MD012778. Susan Redline, M.D., M.P.H. has received consulting fees from Eli Lilly Inc., ApniMed, and Jazz Pharma, all unrelated to this work.

Disclosure statement

Susan Redline, M.D., M.P.H. has received consulting fees from Eli Lilly Inc., ApniMed, and Jazz Pharma, all unrelated to this work. Aside from this and the funding sources listed above, the authors have no competing interests to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review boards of the University of California, Irvine (IRB HS# 2020-5953) and the University of Maryland, College Park (IRB# 1080784-8) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This work was supported by National Institute on Minority Health and Health Disparities: [Grant Number R01MD012778].