Rationale: Sleep constitutes a fundamental pillar of health in individuals and is an indicator of the health of a population. Objectives: Aiming to develop an easy-to-use tool to measure sleep health, we translated to Spanish, adapted, and validated the Satisfaction, Alertness, Timing, Efficiency and Duration (SATED) questionnaire. Methods: The reliability of the questionnaire was evaluated using a sample of 4,385 participants from the 2015 Catalan Health Survey. Criterion validity, construct validity, and feasibility were assessed in an independent sample of 200 subjects who completed the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, anxiety scale of the State-Trait Anxiety Inventory, mood scale of the Profile of Mood States, and a 1-week sleep diary. Results: The SATED questionnaire obtained adequate internal consistency (Cronbach’s α = 0.77), statistically significant correlations of its five items with the total score (rho = 0.55–0.69), and a suitable goodness of fit in the confirmatory factor analysis (χ2 = 30.93; df = 5; P < 0.001; root mean square error of approximation, 0.049; comparative fit index, 0.99; standardized root mean residual, 0.043). The criterion and construct validity were adequate, with correlations in the expected directions. The feasibility of the questionnaire was satisfactory, being easy and intelligible and requiring approximately 1 minute to complete. Conclusions: This questionnaire is reliable and valid for measuring sleep health in the general population. Encouraging the use of SATED is expected to raise awareness that sleep, like diet and physical activity, is a key modifiable factor for promoting health.

Although sleep habits have long been recognized as a promoter of health, the World Health Organization 2014 report on non-communicable diseases (NCDs) only listed smoking, alcohol intake, diet and physical activity (PA) as key modifiable risk factors that could enhance health and prevent NCDs. Cross-sectional data on 4385 surveys from the 2015 Catalan Health Survey, representative of the 2015 non-institutionalized Catalan population over age 14, were used to assess and compare the independent associations of low PA (International Physical Activity Questionnaire (IPAQ): low activity); poor diet (PREvención con DIeta MEDiterránea questionnaire (PREDIMED): low-adherent); poor sleep health (Satisfaction, Alertness, Timing, Efficiency and Duration scale (SATED): <8); smoking status; and, alcohol intake (high-risk drinker based on standard drink units) with having a poor self-perceived health status. Logistic regression models adjusted by age, gender, education level and number of comorbidities showed that poor sleep health had the strongest independent association with poor self-perceived health status (OR = 1.70; 95%CI: 1.37–2.12), followed by poor diet (OR = 1.37; 95%CI: 1.10–1.72) and low PA (OR = 1.31; 95%CI: 1.01–1.69). This suggests that sleep habits should be included among the important modifiable health risk factors and be considered a key component of a healthy lifestyle.

Rationale: Obstructive sleep apnea (OSA) is associated with poor blood pressure (BP) control and resistant hypertension (RH). Nevertheless, studies assessing its prevalence, characteristics, and association with BP control in patients with RH are limited. Objectives: The aim of this multicenter study was to assess the prevalence of OSA in a large cohort of subjects with RH and to evaluate the association of OSA with BP control. Methods: We recruited consecutive subjects with RH from three countries. A formal sleep test and blood pressure measurements, including 24-hour ambulatory blood pressure monitoring, were performed in all participants. Results: In total, 284 subjects with RH were included in the final analysis. Of these, 83.5% (95% confidence interval [CI], 78.7–87.3%) had OSA (apnea–hypopnea index ≥ 5 events/h); 31.7% (95% CI, 26.5–37.3%) had mild OSA, 25.7% (95% CI, 21–31.1%) had moderate OSA, and 26.1% (95% CI, 21.3–31.5%) had severe OSA. Patients with severe OSA had higher BP values than subjects with mild to moderate or no OSA. A greater effect was observed on the average nighttime BP, with an adjusted effect of 5.72 mm Hg (95% CI, 1.08–10.35 mm Hg) in severe OSA compared with participants without OSA. A dose–response association between the severity of OSA and BP values was observed. The prevalence of severe OSA was slightly higher in uncontrolled participants (adjusted odds ratio, 1.69; 95% CI, 0.97–2.99) but was not statistically significant. Conclusions: The present study confirms the high prevalence of OSA in participants with RH. Furthermore, it shows a dose–response association between OSA severity and BP measurements, especially in the nighttime. Clinical trial registered with www.clinicaltrials.gov (NCT03002558).

Continuous positive airway pressure (CPAP) has a heterogeneous effect on blood pressure (BP) in hypertensive patients. However, the effect of CPAP on BP in hypertensive subjects regarding circadian BP pattern has never been explored. This study aimed to assess the effect of CPAP on BP, taking into consideration the circadian BP pattern in untreated hypertensive patients.This study is apost hocanalysis of the Spanish Cohort for the Study of the Effect of CPAP in Hypertension (CEPECTA), a multicentre, randomised trial of CPAPversussham-CPAP in patients with new-onset systemic hypertension and an apnoea–hypopnoea index >15 events·h⁻¹. We included patients for whom 24-h ambulatory BP monitoring (ABPM) data were available at baseline and 12 weeks after the intervention. Subjects were classified based on the dipping ratio (dipper/non-dipper). We evaluated the effect of CPAP on ABPM parameters after 12 weeks of treatment.Overall, 272 hypertensive subjects were included in the analysis (113 dippers and 159 non-dippers). Baseline clinical and polysomnographic variables were similar between the groups. CPAP treatment in non-dipper patients was associated with reductions in 24-h ambulatory BP variables and night-time ambulatory BP measurements. However, a nonsignificant effect was reported in the dipper group. The differential effects of CPAP between the groups were −2.99 mmHg (95% CI −5.92­– −0.06 mmHg) for the mean 24-h ambulatory BP and −5.35 mmHg (95% CI −9.01– −1.69 mmHg) for the mean night-time ambulatory BP.Our results show a differential effect of CPAP treatment on BP in hypertensive patients depending on the circadian pattern. Only non-dipper patients benefited from CPAP treatment in terms of BP reduction.

Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin–angiotensin–aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients’ varying response to CPAP treatment.

Background: Continuous positive airway pressure (CPAP) treatment reduces blood pressure (BP) in obstructive sleep apnoea (OSA) and hypertensive patients, but there is a lack of data about the effects of CPAP on the BP in normotensive patients. Objective: The aim of the study was to evaluate BP changes in normotensive OSA individuals receiving CPAP treatment. Methods: We selected 131 normotensive outpatients with an apnoea/hypopnoea index (AHI) greater than 15 events/hour who required CPAP treatment. All patients underwent a sleep study and 24-h ambulatory BP monitoring (ABPM) at baseline and after 6 months. In addition, the patients were assessed for the presence of baseline masked hypertension, defined as office BP less than 140/90 mmHg and increased BP on 24-h ABPM (mean 24-h BP ≥130/80 mmHg). Results: After 6 months of CPAP treatment, a mild reduction in all 24-h ABPM variables was observed, but only the mean 24-h DBP [−1.39 mmHg, 95% confidence interval (95% CI), −2.50 to −0.27], mean daytime DBP (−1.39 mmHg, 95% CI −2.56 to −0.22) and the mean 24-h ambulatory BP (−1.80 mmHg, 95% CI, −3.16 to −0.44) reached statistical significance. The reduction was primarily due to BP changes in individuals with masked hypertension who displayed a mean BP reduction of −4.78 mmHg (−7.25 to −2.30 mmHg). Consistent with a circadian BP pattern, a reduction in mean nocturnal BP of −4.73 mmHg (−7.39 to −2.06 mmHg) was observed at 6 months in nondippers; in contrast, the mean nocturnal BP in dippers increased by 2.61 mmHg (0.60–4.62 mmHg). Conclusion: Our findings suggest that the CPAP effects may be different in normotensive outpatients depending on the presence of undiagnosed masked hypertension and the dipping pattern. Therefore, it is important to consider measuring ABPM in this type of patient.