Increased daytime tiredness, nocturnal hypertension and sleep apnea: studies in rural general practice]

Studies in a Rural General Practice: Sleep-Related Breathing Disorders (SRBD) and altered circadian blood pressure profile are related to increased cardiovascular risk. We investigated the prevalence and coincidence of both diseases in male patients from a general practice in a small community of 2500 people. Out of 409 selected patients (using a questionnaire regarding symptoms and findings of SRBD), 185 were monitored in an outpatient setting with an apnoea-screening system Mesam IV. Ambulatory blood pressure monitoring (Spacelabs 90207). Holter-ECG and actigraphy were also measured. Sixty patients had a Respiratory Disturbance Index (RDI) > 10. An indication for further sleep studies was seen in 40 patients; 36.5% of daytime hypertensives were "Non-Dipper", and 47.6% of normotensives were also "Non-Dipper". Excessive daytime sleepiness (EDS) is an important symptom of SRBD, and in this investigation we noticed a large number of patients without this symptom suffering from relevant SRBD. Therefore, absence of EDS alone is not indicative for the use of ambulatory monitoring.