Reciprocal interactions of obstructive sleep apnea and hypertension associated with ACE I/D polymorphism in males

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Koyama, Renata G. [UNIFESP]
Drager, Luciano F.
Lorenzi-Filho, Geraldo
Cintra, Fatima D. [UNIFESP]
Pereira, Alexandre C.
Poyares, Dalva [UNIFESP]
Krieger, Jose Eduardo
Castro, Rosa M. R. P. S. [UNIFESP]
Tufik, Sergio [UNIFESP]
Mello, Marco Tulio de [UNIFESP]
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Background: the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism gene contributes to the genesis of hypertension (HTN) and may help explain the relationship between obstructive sleep apnea (OSA) and HTN. However, ACE is a pleiotropic gene that has several influences, including skeletal muscle and control of ventilation. We therefore tested the hypothesis that ACE polymorphism influences OSA severity.Methods: Male OSA patients (apnea-hypopnea index [AHI] > 5 events/h) from 2 university sleep centers were evaluated by polysomnography and ACE I/D polymorphism genotyping.Results: We studied 266 males with OSA (age = 48 +/- 13y, body mass index = 29 5kg/m(2), AHI = 34 +/- 25events/h). HTN was present in 114 patients (43%) who were older (p < 0.01), heavier (p < 0.05) and had more severe OSA (p < 0.01). the I allele was associated with HTN in patients with mild to moderate OSA (p < 0.01), but not in those with severe OSA. ACE I/D polymorphism was not associated with apnea severity among normotensive patients. in contrast. the only variables independently associated with OSA severity among patients with hypertension in multivariate analysis were BMI (OR = 1.12) and 11 genotype (OR = 0.27).Conclusions: Our results indicate reciprocal interactions between OSA and HTN with ACE I/D polymorphism, suggesting that among hypertensive OSA males, the homozygous ACE I allele protects from severe OSA. (C) 2009 Elsevier B.V. All rights reserved.
Sleep Medicine. Amsterdam: Elsevier B.V., v. 10, n. 10, p. 1107-1111, 2009.