Diuretics Linked With OSA Severity Reduction in Patients With Moderate Obesity, Hypertension

In patients with hypertension who are overweight or moderately obese, diuretics were shown to potentially reduce the severity of obstructive sleep apnea (OSA), according to study findings published in the journal Chest.

OSA, diagnosed singularly or as a comorbid disorder, can contribute to higher costs and healthcare utilization among those affected. Additionally, in patients with diabetes, sleep apnea was linked with complications of impaired vision and potential blindness. Sodium-glucose cotransporter 2 inhibitors, which provide a diuretic effect, have been shown to be helpful in controlling hypertension, indicating the potential of diuretics in promoting weight loss for those with cormid OSA.

As researchers note, it has been reported that diuretics can be effective for reducing OSA severity by preventing fluid retention and reducing rostral fluid shift. As this benefit may vary depending on a patient’s OSA clinical phenotype and comorbidities, study authors conducted a propensity score—matched cohort analysis of data to determine the impact of diuretics on OSA severity.

Researchers derived data on 69,564 patients with OSA (apnea-hypopnea index [AHI] >5 events/hour) from the French national sleep apnea registry Observatoire Sommeil de la Fédération de Pneumologie. Participants on diuretics (n = 9783; 14%) were compared with those without by a Fisher exact/χ² test (for qualitative variables) and a nonparametric Mann-Whitney test (quantitative variables). Severe OSA was defined as AHI greater than 30 events per hour.

In the study cohort, median (interquartile range) AHI was shown to be 28 (14-43) events per hour.

Compared with patients not on diuretics, those on diuretics who were overweight or moderately obese exhibited reduced OSA severity (P = .03). Reductions in OSA severity were also shown in patients with hypertension (P <.01), particularly in those with a body mass index between 25 and 35 kg/m² (P <.01). However, diuretics had no significant effect on OSA severity among patients with self-reported low physical activity or heart failure.

“Fluid redistribution from the legs to the neck during sleep contributes to the severity of OSA in patients with hypertension,” explained the study authors. Researchers noted that further research is warranted to identify which class of diuretics would best suit patients with this distinct pathophysiological phenotype, “overweight or moderately obese patients with OSA and hypertension.”

Reference

Revol B, Jullian-Desayes I, Bailly S, et al. Who may benefit from diuretics in OSA? A propensity score-match observational study [published online February 28, 2020]. Chest. doi: 10.1016/j.chest.2020.01.050.