Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2023; 11(30): 7309-7317
Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7309
High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study
Wei-Nung Liu, Ko-Huan Lin, Kun-Zhe Tsai, Chen-Chih Chu, Yun-Chen Chang, Younghoon Kwon, Gen-Min Lin
Wei-Nung Liu, Chen-Chih Chu, Gen-Min Lin, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ko-Huan Lin, Department of Psychiatry, Hualien Tzu Chi Hospital, Hualien City 970, Taiwan
Kun-Zhe Tsai, Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei 104, Taiwan
Yun-Chen Chang, School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung 406, Taiwan
Younghoon Kwon, Department of Medicine, University of Washington, Seattle, 98104-2499, United States
Gen-Min Lin, Department of Medicine, Hualien Armed Forces General Hospital, Hualien City 970, Taiwan
Author contributions: Liu WN wrote the article; Lin KH collected the data; Lin GM and Lin KH contributed to conception and design of the CHIEF sleep study, and acquired and interpreted the data; Tsai KZ analyzed the data; Chu CC and Chang YC collected and reviewed the data; Younghoon kwon edited and made critical revisions related to important intellectual content of the manuscript; All authors provided approval of the final version of the article to be published.
Supported by the Medical Affairs Bureau Ministry of National Defense, No. MND-MAB-D-112182; Hualien Armed Forces General Hospital, No. HAFGH-D-112004.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Mennonite Christian Hospital (No. 16-05-008) in Hualien City, Taiwan.
Informed consent statement: The written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
Data sharing statement: As the CHIEF study materials were obtained from the military in Taiwan, the data were confidential and not allowed to be opened in public. If there are any needs for clarification, the readers can contact Dr. Lin, the corresponding author, for sharing the data.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gen-Min Lin, FACC, FAHA, MD, PhD, Academic Editor, Academic Fellow, Chief Physician, Department of Medicine, Hualien Armed Forces General Hospital, No. 100 Jinfeng Street, Hualien City 970, Taiwan. farmer507@yahoo.com.tw
Received: July 28, 2023
Peer-review started: July 28, 2023
First decision: September 19, 2023
Revised: September 21, 2023
Accepted: September 28, 2023
Article in press: September 28, 2023
Published online: October 26, 2023
Processing time: 88 Days and 18.1 Hours
ARTICLE HIGHLIGHTS
Research background

Previous studies have revealed an association between obstructive sleep apnea (OSA) and hypertension in the general population, whereas the association in military personnel was rarely investigated.

Research motivation

Military personnel have some risk factors for both OSA and hypertension, e.g. night duty which are rarely seen in the general population.

Research objectives

To investigate the association between high risk for OSA and hypertension by phenotypes in military young adults.

Research methods

A total of 746 military personnel, aged 27.9 years, were included in the cardiorespiratory fitness and health in armed forces (CHIEF)-sleep study in Taiwan in 2020. Antihypertensive medications were not used by the subjects. High risk for OSA was assessed using the Berlin Questionnaire. Hypertension was defined using the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. The cutoff levels of systolic and diastolic blood pressure (SBP and DBP) for the 2017 ACC/AHA- and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg, respectively. Hypertension phenotypes included isolated systolic and diastolic hypertension (ISH, high SBP only and IDH, high DBP only) and combined hypertension (both high SBP and DBP). Multivariable logistic regression analysis with adjustment for demographics, lifestyle and metabolic biomarkers.

Research results

The prevalence of high risk for OSA, JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%, 5.2% and 22.0%, respectively. Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension (odds ratios (ORs) and 95% confidence intervals: 2.82 (1.07, 7.42) and 7.54 (1.10, 51.54), although the probabilities of ISH and IDH were unaffected by a high risk for OSA (ORs: 1.96 and 2.35, respectively, both P > 0.05). In contrast, no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.

Research conclusions

High risk for OSA, as assessed by the Berlin Questionnaire, accounted for 8.0 % of the military population and was associated with a higher probability of uncontrolled BP levels, defined by the JNC 7 criterion. Notably, the association was not related to obesity or older age.

Research perspectives

For military personnel, polysomnography should be used to define OSA for its relationship with hypertension risk in future studies. In addition, night activity confounded the association in the military personnel requires further study.