Diuretics may reduce the severity of obstructive sleep apnea (OSA) in individuals with hypertension who are overweight or moderately obese, according to study results published in CHEST. 

This study included 101,791 individuals, 69,564 of whom had OSA (apnea-hypopnea index [AHI] or oxygen desaturation index [ODI] >5 events/h). All data were collected from the Sleep Registry of the French Pneumology Federation. To compare participants on diuretics with those not on diuretics, a Fisher exact/chi-squared test (qualitative variables) and a nonparametric Mann-Whitney test (quantitative variables) were used. To account for confounders, a propensity score method was used. A 1:4 matching ratio of diuretic to nondiuretic participants was used, with a collider of 0.1 for propensity score, which was chosen because of simplicity and generally good performance. An AHI of >30 events/h was defined as severe OSA.

In the study population, the median AHI was 28 events per hour (interquartile range [IQR] 14-43 events/h), and 14.1% (n=9783) of individuals with OSA were on diuretic treatment when diagnosed. Diuretics exhibited a significant reduction in the risk for severe OSA in individuals who were overweight or moderately obese with body mass index (BMI) 25 to 30 kg/m2 (odds ratio [OR] 0.81; 95% CI, 0.71-0.92; P <.01) or with BMI 30 to 35 kg/m2 (OR, 0.83; 95% CI, 0.73-0.95; P <.01). However, no association was found between diuretic use and OSA severity in patients with sedentary lifestyles or heart failure


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Study limitations included unrecorded diuretic prescription parameters during AHI measurement, the potential for a small proportion of central sleep apnea, potential inclusion bias, a lack of data on renal disease, and inability to differentiate heart failure with preserved ejection fraction from that with reduced ejection fraction. 

The study researchers concluded that “fluid redistribution from the legs to the neck during sleep contributes to the severity of OSA in patients with hypertension” and could represent a link between the conditions; furthermore, a correlation was found between “diuretic use and decreased severity of OSA in overweight or moderately obese and/or hypertensive patients.” However, the researchers stated the need for a prospective study to elucidate these results and “identify which class of diuretics is of interest in this distinct pathophysiological patient phenotype: overweight or moderately obese patients with OSA and hypertension.”

Reference

Revol B, Jullian-Desayes I, Bailly S, et al; on behalf of the OSFP National French Registry Scientific Council 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