Abstract
BACKGROUND: Emerging evidence highlights the interplay between obstructive sleep apnea (OSA) and resistant hypertension. Therefore, we aimed to explore the association between OSA and uncontrolled hypertension in the Korean middle-aged population. METHODS: This cross-sectional study utilized data from the 2019-2020 Korea National Health and Nutrition Examination Survey participants aged 40-59. OSA was identified using the STOP-BANG questionnaire, whereas hypertension control was defined as a systolic blood pressure of < 140 mmHg and a diastolic blood pressure of < 90 mmHg, with stricter criteria for those with diabetes. The sociodemographic and health-related characteristics of the participants with and without OSA were evaluated. Finally, univariate and multivariate logistic analyses were performed to investigate the association between OSA and hypertension control. RESULTS: Of the 4,061 patients aged 40-59, 725 (17.9%) were identified as OSA. The proportion of patients diagnosed with hypertension was significantly higher in the OSA group than in the non-OSA group (48.1% vs. 10.5%, P < 0.001). The prevalence of uncontrolled hypertension was significantly higher in the OSA group, both among those with diagnosed hypertension (45.5% vs. 32.6%, P = 0.003) and those taking antihypertensive medication (39.8% vs. 30.1%, P = 0.024). After adjusting for confounders, OSA (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.02-2.26), diabetes (aOR, 1.70; 95% CI, 1.10-2.64), and male sex (aOR, 1.68; 95% CI, 1.05-2.71) were significantly associated with uncontrolled hypertension in patients with hypertension aged 40-59 years despite using antihypertensive medication. CONCLUSION: This study highlights a significant association between OSA and uncontrolled hypertension in the middle-aged Korean population and emphasizes the need for routine OSA screening in patients with hypertension at this age. Integrating OSA management into hypertension treatment could improve blood pressure control and reduce cardiovascular risk.