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Obstructive Sleep Apnea, Short Sleep Duration and Drug Adherence in Patients with Hypertension: The ELSA-Brasil study


Hypertension (HTN) is the leading cause of cardiovascular mortality. One of the crucial steps for its successful treatment is the appropriate adherence to the anti-hypertensive therapy. It is conceivable that sleep disorders such as Obstructive Sleep Apnea (OSA) and Short Sleep Duration (SSD) may impair this adherence due to poor sleep quality and potential impact on cognitive performance but the evidence is scanty.


To evaluate the association between OSA and SSD with the adherence to antihypertensive treatment in civil servants from the ELSA-Brasil cohort study.


Consecutive participants with a previous diagnosis of HTN under specific drug treatment performed clinical evaluation, home sleep monitoring (Embletta GoldTM) for one night and wrist actigraphy (Actiwatch2TM) for seven days to determine OSA and SSD, respectively. OSA was defined by an apnea-hypopnea index ≥15 events/hour. SSD was defined by a mean sleep duration <6 hours. Adherence to therapy was evaluated by the 4-itens Morisky questionnaire. We defined poor/medium adherence by the presence of >0 score. We performed a logistic regression analysis to evaluate the predictors of poor/medium medication adherence in these participants.


A total of 411 hypertensive participants were analyzed (mean age: 54±8 years, 47% men). Medium/low adherence to anti-hypertensive therapy were observed in 62%. Compared to the high adherence (score=0), the participants with medium/poor adherence had higher frequency of excessive daytime sleepiness (35.9 vs. 46.1%), lower frequency of high degree education (50.6 vs. 40%) and lower monthly per capita income ($1021.9 vs. $805.2). No differences were observed for OSA (50.6 vs. 47.5%) and SSD (24.4 vs. 29%). Logistic regression analysis showed that race other than whites (OR: 1.66;95% IC: 1.06-2.61), lower per capita income (OR: 1.76;95% IC: 1.05-2.94) and excessive daytime sleepiness (OR: 1.55;95% IC: 1.01-2.40) were the independent variables associated with medium/poor adherence to anti-hypertensive treatment.


In a large cohort of patients with HTN, non white race, lower economical status, escessive daytime sleepiness, but not OSA or SSD, were associated to impaired adherence to anti-hypertensive therapy.


Sleep Apnea, sleep duration, Medication Adherence, hypertension


Área Clínica


Hospital Universitário - USP - Sao Paulo - Brasil


Aline Nogueira Aielo, Ronaldo Batista Santos, Soraya Giatti, Wagner Silva, Silvana P Souza, Lorenna Cunha, Isabela M Bensenor, Paulo Lotufo, Luciano Ferreira Drager