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Abstract
There are lines of evidence from experimental sleep deprivation studies, population-based epidemiological studies, and an interventional study that point to the potential efficacy of adequate quality sleep to prevent and treat hypertension. Experimental sleep restriction has been shown to raise blood pressure and heart rate. Insufficient sleep on a chronic basis can raise average 24-hour blood pressure and lead to structural adaptations that entrain the cardiovascular system to operate at an elevated blood pressure equilibrium and increase the risk for hypertension. Disruptions in the timing and duration of sleep could also disrupt circadian rhythmicity and autonomic balance, which can increase the prevalence of the nondipping pattern, disturb diurnal rhythm of cardiac output, and increase blood pressure variability. Short sleep duration has been found to be associated with higher blood pressure and hypertension in both cross-sectional and longitudinal epidemiological studies. The association appears stronger in middle-aged adults and in women. Experimental sleep extension has been shown to significantly reduce blood pressure in individuals with prehypertension or stage 1 hypertension. The observed association between sleep duration and hypertension raises the hypothesis that interventions to extend sleep and improve sleep quality could serve as effective primary, secondary, and tertiary preventive measures for hypertension.
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Affiliation(s)
- James E Gangwisch
- Division of Experimental Therapeutics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.
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Huang YC, Lin CY, Lan CC, Wu YK, Lim CS, Huang CY, Huang HL, Yeh KH, Liu YC, Yang MC. Comparison of cardiovascular co-morbidities and CPAP use in patients with positional and non-positional mild obstructive sleep apnea. BMC Pulm Med 2014; 14:153. [PMID: 25257571 PMCID: PMC4189203 DOI: 10.1186/1471-2466-14-153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This retrospective cohort study aimed to determine if there are differences in cardiovascular co-morbidities, blood pressure (BP) and continuous positive airway pressure (CPAP) use between patients with positional-dependent and nonpositional-dependent obstructive sleep apnea (OSA). METHODS Patients who were referred for overnight polysomnography for suspected OSA between 2007 and 2011 were screened. A total of 371 patients with OSA were included for analysis and divided into six groups according to positional-dependency and severity of OSA: positional mild (n = 52), positional moderate (n = 29), positional severe (n = 24), non-positional mild (n = 18), non-positional moderate (n = 70) and non-positional severe group (n = 178). The six groups were compared for anthropometric and polysomnographic variables, presence of cardiovascular co-morbidities, morning and evening BP and the changes between evening and morning BP, and CPAP device usage patterns. RESULTS Demographic and anthropometric variables showed non-positional severe OSA had poor sleep quality and higher morning blood pressures. Positional mild OSA had the lowest cardiovascular co-morbidities. Overall CPAP acceptance was 45.6%. Mild OSA patients had the lowest CPAP acceptance rate (10%), followed by moderate group (37.37%) and severe group (61.88%, P < 0.001). However, the significant difference in CPAP acceptance across OSA severity disappeared when the data was stratified by positional dependency. CONCLUSIONS This study found that positional mild OSA had less cardiovascular co-morbidities compared with subjects with positional severe OSA. Independent of posture, CPAP acceptance in patients with mild OSA was low, but CPAP compliance was similar in CPAP acceptors regardless of posture dependency of OSA. Since there are increasing evidences of greater cardiovascular risk for untreated mild OSA, improving CPAP acceptance among mild OSA patients may be clinically important regardless of posture dependency.
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Affiliation(s)
- Yi-Chih Huang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Chun-Yao Lin
- />Divisions of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Chou-Chin Lan
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chor-Shen Lim
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Chun-Yao Huang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Hsuan-Li Huang
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
- />Division of Cardiology, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Kuan-Hung Yeh
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
- />Division of Cardiology, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Yu-Chih Liu
- />Divisions of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Mei-Chen Yang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
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105
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Mehari A, Weir NA, Gillum RF. Gender and the association of smoking with sleep quantity and quality in American adults. Women Health 2014; 54:1-14. [PMID: 24261545 DOI: 10.1080/03630242.2013.858097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Smoking and gender are known risk factors for sleep disorders. Studies of samples from Norway and Japan have suggested stronger associations between smoking and disrupted sleep in women; therefore, we examined, gender differences in the association in the U.S. population. We analyzed data from the 2005-2006 National Health and Nutrition Examination Survey. We examined the associations between smoking and self-reported measures of sleep disorders (i.e., snoring, short sleep, long sleep, poor sleep, and health care provider diagnosis of sleep disordered breathing) using multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (CI) as measures of association. We also assessed whether the associations varied by gender using a gender x smoking interaction term. Compared to never smokers, current smokers had significantly higher odds of self-reported snoring (OR = 2.0; 95% CI = 1.56-2.56), short sleep (OR 1.68; 95% CI = 1.35-2.10) and poor sleep (OR = 1.38; 95% CI = 1.09-1.74). A dose-response relationship was observed between the amount smoked and sleep symptoms. In multivariate analyses, no significant gender x smoking interaction was observed for snoring, short sleep or poor sleep. Current smoking was independently associated with increased odds of snoring, short sleep, and poor sleep in women and men among U.S. adults.
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Affiliation(s)
- Alem Mehari
- a Division of Pulmonary Medicine, Department of Medicine , Howard University , Washington , DC , USA
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106
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Liu R, Liu X, Zee PC, Hou L, Zheng Z, Wei Y, Du J. Association between sleep quality and C-reactive protein: results from national health and nutrition examination survey, 2005-2008. PLoS One 2014; 9:e92607. [PMID: 24663098 PMCID: PMC3963926 DOI: 10.1371/journal.pone.0092607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/24/2014] [Indexed: 12/03/2022] Open
Abstract
Objective Our objective was to explore the association between poor sleep quality and hs_CRP in an adult U.S. population. Methods This study focused on 9,317 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005–2008 who were aged 20–85 years, completed a sleep disorder questionnaire, and had available information on serum hs_CRP. Sleep quality was classified into three categories (good, moderate, poor) based on the responses of participants to the NHANES sleep disorder questionnaire. High CRP was defined as hs-CRP >1 md/dL. Linear regression model was applied to investigate the association between poor sleep quality and log-transformed hs_CRP. And logistic regression model was fitted to evaluate the association between sleep quality and the risk of high CRP. Results Females were more likely to report poor sleep quality than males (26% vs. 19%, p<0.0001). Each sleep disorder was significantly associated with increased hs_CRP and correlative to other sleep disorders. In fully-adjusted linear regression model, poor sleep quality was significantly associated with elevated hs_CRP (log transformed) among the overall sample and in females only (β = 0.10, se = 0.03, p<0.01 and β = 0.13, se = 0.04, p<0.01, respectively). In fully-adjusted logistics regression model, poor sleep quality was linked with risk of high CRP(OR: 1.42, 95%CI: 1.15–1.76 in overall sample and OR: 1.59, 95%CI: 1.18–2.14 in females, respectively). Conclusion We found that poor sleep quality was independently associated with elevated hs_CRP in females but not in males in a U.S. adult population.
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Affiliation(s)
- Rong Liu
- Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and Children's Hospital of Chicago Research Center, Chicago, Illinois, United States of America
- * E-mail: (RL); (JD)
| | - Xin Liu
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and Children's Hospital of Chicago Research Center, Chicago, Illinois, United States of America
| | - Phyllis C. Zee
- Department of Neurology and Sleep Medicine Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Zheng Zheng
- Department of Neurobiology, Beijing Institute of Geriatrics, Beijing Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otorhinolaryngology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Jie Du
- Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- * E-mail: (RL); (JD)
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Pepin JL, Borel AL, Tamisier R, Baguet JP, Levy P, Dauvilliers Y. Hypertension and sleep: overview of a tight relationship. Sleep Med Rev 2014; 18:509-19. [PMID: 24846771 DOI: 10.1016/j.smrv.2014.03.003] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 01/12/2023]
Abstract
Autonomic cardiovascular control changes across sleep stages. Thus, blood pressure (BP), heart rate and peripheral vascular resistance progressively decrease in non-rapid eye movement sleep. Any deterioration in sleep quality or quantity may be associated with an increase in nocturnal BP which could participate in the development or poor control of hypertension. In the present report, sleep problems/disorders, which impact either the quality or quantity of sleep, are reviewed for their interaction with BP regulation and their potential association with prevalent or incident hypertension. Obstructive sleep apnea syndrome, sleep duration/deprivation, insomnia, restless legs syndrome and narcolepsy are successively reviewed. Obstructive sleep apnea is clearly associated with the development of hypertension that is only slightly reduced by continuous positive airway pressure treatment. Shorter and longer sleep durations are associated with prevalent or incident hypertension but age, gender, environmental exposures and ethnic differences are clear confounders. Insomnia with objective short sleep duration, restless legs syndrome and narcolepsy may impact BP control, needing additional studies to establish their impact in the development of permanent hypertension. Addressing sleep disorders or sleep habits seems a relevant issue when considering the risk of developing hypertension or the control of pre-existent hypertension. Combined sleep problems may have potential synergistic deleterious effects.
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Affiliation(s)
- Jean-Louis Pepin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France.
| | - Anne-Laure Borel
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, Endocrinology Department, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France
| | | | - Patrick Levy
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hopital-Gui-de Chauliac, CHU Montpellier, National Reference Network for Narcolepsy, and INSERM U1061, Montpellier, France
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Eshkoor SA, Hamid TA, Nudin SSH, Mun CY. Importance of hypertension and social isolation in causing sleep disruption in dementia. Am J Alzheimers Dis Other Demen 2014; 29:61-6. [PMID: 24085252 PMCID: PMC11007885 DOI: 10.1177/1533317513505136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This study aimed to determine the effects of diabetes mellitus (DM), hypertension (HT), heart disease, social isolation, and sociodemographic factors on sleep in the elderly patients with dementia. Samples included 1210 noninstitutionalized, Malaysian elderly patients with dementia. The multiple logistic regression analysis was applied to estimate the risk of sleep disturbances among respondents. Approximately 41% of the patients experienced sleep problems. The results showed that age (odds ratio [OR] = 1.02), social isolation (OR = 1.33), and HT (OR = 1.53) significantly increased sleep disruption in respondents (P <.05). Furthermore, education (OR =.63) and non-Malay ethnicity (OR = 0.63) significantly decreased sleep problems (P <.05). It was found that DM, heart disease, sex differences, and marital status were not significant predictors of sleep disturbances (P >.05). It was concluded that age, social isolation, and HT increased sleep disruption but education and ethnic non-Malay reduced the risk of sleep problems. Moreover, HT was the most important variable to increase sleep disturbances in the elderly patients with dementia.
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Affiliation(s)
| | | | | | - Chan Yoke Mun
- Institute of Gerontology, Universiti Putra Malaysia, Selangor, Malaysia
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109
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Buman MP, Winkler EAH, Kurka JM, Hekler EB, Baldwin CM, Owen N, Ainsworth BE, Healy GN, Gardiner PA. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006. Am J Epidemiol 2014; 179:323-34. [PMID: 24318278 DOI: 10.1093/aje/kwt292] [Citation(s) in RCA: 283] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sleep and sedentary and active behaviors are linked to cardiovascular disease risk biomarkers, and across a 24-hour day, increasing time in 1 behavior requires decreasing time in another. We explored associations of reallocating time to sleep, sedentary behavior, or active behaviors with biomarkers. Data (n = 2,185 full sample; n = 923 fasting subanalyses) from the cross-sectional 2005-2006 US National Health and Nutrition Examination Survey were analyzed. The amounts of time spent in sedentary behavior, light-intensity activity, and moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometry (ActiGraph LLC, Pensacola, Florida), and respondents reported their sleep duration. Isotemporal substitution modeling indicated that, independent of potential confounders and time spent in other activities, beneficial associations (P < 0.05) with cardiovascular disease risk biomarkers were associated with the reallocation of 30 minutes/day of sedentary time with equal time of either sleep (2.2% lower insulin and 2.0% lower homeostasis model assessment of β-cell function), light-intensity activity (1.9% lower triglycerides, 2.4% lower insulin, and 2.2% lower homeostasis model assessment of β-cell function), or MVPA (2.4% smaller waist circumference, 4.4% higher high-density lipoprotein cholesterol, 8.5% lower triglycerides, 1.7% lower glucose, 10.7% lower insulin, and 9.7% higher homeostasis model assessment of insulin sensitivity. These findings provide evidence that MVPA may be the most potent health-enhancing, time-dependent behavior, with additional benefit conferred from light-intensity activities and sleep duration when reallocated from sedentary time.
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110
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Hannon TS, Tu W, Watson SE, Jalou H, Chakravorty S, Arslanian S. Morning blood pressure is associated with sleep quality in obese adolescents. J Pediatr 2014; 164:313-7. [PMID: 24252787 PMCID: PMC3946868 DOI: 10.1016/j.jpeds.2013.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/22/2013] [Accepted: 10/03/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine relationships among blood pressure (BP), adiposity, and sleep quality with the use of overnight polysomnography in obese adolescents. STUDY DESIGN Overnight polysomnogram and morning BP measurements were performed in obese (body mass index [BMI] >95th percentile) nondiabetic adolescents (eligible age range 12-18 years, n = 49). Subjects were stratified into 2 groups, one with normal BP, and one with elevated BP, and demographic and clinical characteristics were compared between the groups. Multiple linear regression analysis was used to assess the effects of sleep quality on BP. RESULTS Participants (n = 27) had a normal morning BP, and 22 (44.9%) had elevated morning BP. There were no differences in age (P = .53), sex (P = .44), race (P = .58), or BMI (P = .56) between the 2 BP groups. The group with elevated BP spent shorter percentages of time in rapid eye movement (REM; P = .006) and slow-wave sleep (SWS; P = .024). Multiple linear regression analysis showed that a lower percentage of both REM and SWS was associated with increased morning BP after we adjusted for pubertal stage, sex, race, and BMI. CONCLUSION Lack of deeper stages of sleep, REM sleep, and SWS is associated with greater morning BP in obese adolescents, independent of BMI. Poor sleep quality should be considered in the work-up of obese youth with hypertension. Intervention studies are needed to evaluate whether improving the quality of sleep will decrease BP elevation.
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Affiliation(s)
- Tamara S. Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46022
| | - Wanzhu Tu
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46022
| | - Sara E. Watson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46022
| | - Hasnaa Jalou
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46022
| | - Sangeeta Chakravorty
- Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224
| | - Silva Arslanian
- Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224
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111
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Association between sleep quality and cardiovascular health: a door-to-door survey in rural Ecuador. Environ Health Prev Med 2014; 19:234-7. [PMID: 24477858 DOI: 10.1007/s12199-014-0379-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Cardiovascular correlates of sleep disorders have not been well investigated in underserved populations. The aim of this door-to-door survey was to evaluate the association between sleep quality and cardiovascular health status in persons aged ≥40 years living in a village that is representative of rural Ecuador. METHODS All stroke-free Atahualpa residents aged ≥40 years were screened with a validated Spanish version of the Pittsburgh Sleep Quality Index and the seven cardiovascular health (CVH) metrics proposed by the American Heart Association to assess the CVH status. RESULTS A total of 635 persons (mean age 59 ± 13 years; 58 % women) were identified. A poor sleep quality was present in 27 % of the subjects (95 % CI 24-31 %) and a poor cardiovascular health in 69 % (95 % CI 63-71 %). In a multivariate logistic regression model, a poor sleep quality was associated with some CVH metrics in the poor range, including smoking status (p = 0.026), physical activity (p = 0.01) and blood glucose levels (p = 0.036). CONCLUSIONS A poor sleep quality may be linked to individual cardiovascular risk factors in this underserved Latin American population. This finding provides useful insights for the implementation of regional prevention priorities.
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112
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Grandner MA, Chakravorty S, Perlis ML, Oliver L, Gurubhagavatula I. Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors. Sleep Med 2014; 15:42-50. [PMID: 24333222 PMCID: PMC3947242 DOI: 10.1016/j.sleep.2013.09.012] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 09/13/2013] [Accepted: 09/19/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues. METHODS Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5649). Self-reported sleep duration was categorized as very short (<5 h), short (5-6 h), normal (7-8 h), or long (≥9 h). Obesity, diabetes mellitus (DM), hypertension, and hyperlipidemia were objectively assessed by self-reported history. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses and cardiometabolic factor as outcome, with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity. RESULTS In adjusted analyses, very short sleep was associated with self-reported hypertension (odds ratio [OR], 2.02, [95% confidence interval {CI},1.45-2.81]; P<0.0001), self-reported hyperlipidemia (OR, 1.96 [95% CI, 1.43-2.69]; P<0.0001), objective hyperlipidemia (OR, 1.41 [95% CI, 1.04-1.91]; P=0.03), self-reported DM (OR, 1.76 [95% CI, 1.13-2.74]; P=0.01), and objective obesity (OR, 1.53 [95% CI, 1.03-1.43]; P=0.005). Regarding short sleep (5-6 h), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR, 1.22 [95% CI, 1.02-1.45]; P=0.03) self-reported obesity (OR, 1.21 [95% CI, 1.03-1.43]; P=0.02), and objective obesity (OR, 1.17 [95% CI, 1.00-1.38]; P<0.05). Regarding long sleep (≥9 h), no elevated risk was found for any outcomes. Interactions with race/ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among blacks and the relationship between short sleep and hypertension is strongest among non-Hispanic whites, blacks, and non-Mexican Hispanics/Latinos. CONCLUSIONS Short sleep duration is associated with self-reported and objectively determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.
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Affiliation(s)
- Michael A Grandner
- Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Subhajit Chakravorty
- Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Michael L Perlis
- Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Linden Oliver
- Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Indira Gurubhagavatula
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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113
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Weber MA. Exploring Issues in Difficult-to-Treat Hypertension. J Clin Hypertens (Greenwich) 2013; 15:859-64. [DOI: 10.1111/jch.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Michael A. Weber
- Division of Cardiovascular Medicine; Downstate College of Medicine; State University of New York; Brooklyn NY
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The relationship between insomnia symptoms and hypertension using United States population-level data. J Hypertens 2013; 31:663-71. [PMID: 23391985 DOI: 10.1097/hjh.0b013e32835ed5d0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine if the association with hypertension was different between individuals with and without insomnia symptoms. METHODS This was a population-based, multiyear, cross-sectional study with data from the 2005-2008 United States National Health and Nutrition Examination Surveys (n = 12,643). Insomnia symptoms were considered if at least one of difficulty falling asleep, prolonged nocturnal awakening, or early morning awakening was reported, at least five times per month. Short sleep time (<6 h) was also considered in the insomnia definition. Ever doctor-diagnosed self-reported hypertension, self-reported current antihypertensive use, and objectively measured systolic and diastolic hypertension were examined. RESULTS There were generally no associations between insomnia symptoms and hypertension when sleep duration was not considered in the insomnia definition and after controlling for covariates. However, there were significantly increased odds of subjective hypertension measures among individuals with insomnia coupled with short sleep time compared to individuals without insomnia after controlling for covariates [e.g. among individuals with any insomnia: odds ratio (OR), 95% confidence interval (CI) of doctor-diagnosed hypertension 1.49, 1.19-1.88; OR, 95% CI of current antihypertensive medications 1.33, 1.04-1.70]. There were no significant associations though between insomnia symptoms accompanied by short sleep time and objective hypertension measures (e.g. among individuals with any insomnia: OR, 95% CI of measured systolic hypertension 1.32, 0.87-2.02; OR, 95% CI of measured diastolic hypertension 0.96, 0.52-1.75). CONCLUSION Insomnia symptoms coupled with short sleep time may be positively related to hypertension, but the lack of association with objective hypertension measures suggests that there may be no true relationship present.
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Adenekan B, Pandey A, McKenzie S, Zizi F, Casimir GJ, Jean-Louis G. Sleep in America: role of racial/ethnic differences. Sleep Med Rev 2013; 17:255-62. [PMID: 23348004 PMCID: PMC3644542 DOI: 10.1016/j.smrv.2012.07.002] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 07/20/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting that the population's current average sleep duration is approximately 6 h. In this paper, we examine epidemiologic and community-based data on sleep complaints reported by American adults, specifically addressing the role of race/ethnicity in the subjective report of sleep problems. Subjective and objective findings indicate that black (throughout the text, we use the term black in lieu of African American for there are instances where we refer to individuals with self-ascribed race/ethnicity as black, African American, African, or Caribbean American; the term white is used to denote individuals of European descent). Americans have higher rates of long (≥9 h) and short (≤5 h) sleep than their white counterparts, and this may mediate a higher risk of cardiovascular disease, obesity and diabetes among blacks. In addition, studies show mixed results on sleep complaints among blacks compared to those among other ethnicities. This paper explores factors that may contribute to racial/ethnic differences in sleep including intra-ethnic variation, cultural biases, genetics and psychosocial factors.
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Affiliation(s)
- Bosede Adenekan
- Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, NY 11203-2098, USA
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Torre-Bouscoulet L, Garcia Sancho C, Vázquez García JC, Salazar-Peña CM, Lopez Varela MV, de Oca MM, Muiño A, Tálamo C, Valdivia G, Menezes AMB, Perez-Padilla R. Perceptions of short and long sleep duration and comorbid conditions: the PLATINO study. Sleep Med 2013; 14:850-7. [PMID: 23856294 DOI: 10.1016/j.sleep.2013.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). METHODS Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. RESULTS The prevalence of subjects who reported sleeping <7h was 38.4%, ≥ 7 to <9h was 51.4%, and ≥ 9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. CONCLUSIONS Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.
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Affiliation(s)
- Luis Torre-Bouscoulet
- Head of Department of Research in Epidemiology and Social Sciences in Health, National Institute of Respiratory Diseases, Mexico
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Association between weekend catch-up sleep duration and hypertension in Korean adults. Sleep Med 2013; 14:549-54. [DOI: 10.1016/j.sleep.2013.02.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/04/2013] [Accepted: 02/08/2013] [Indexed: 11/15/2022]
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Guo X, Zheng L, Wang J, Zhang X, Zhang X, Li J, Sun Y. Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med 2013; 14:324-32. [PMID: 23394772 DOI: 10.1016/j.sleep.2012.12.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/29/2012] [Accepted: 12/10/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively. METHODS We performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed. RESULTS Twenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106 years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09-1.34; P<0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04-1.18; P=0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06-1.42; P=0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91-1.14; P=0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity. CONCLUSIONS Among adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, People's Republic of China
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Effects of aroma massage on home blood pressure, ambulatory blood pressure, and sleep quality in middle-aged women with hypertension. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:403251. [PMID: 23431338 PMCID: PMC3570933 DOI: 10.1155/2013/403251] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/08/2012] [Accepted: 12/09/2012] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to evaluate the effects of aroma massage applied to middle-aged women with hypertension. The research study had a nonequivalent control group, nonsynchronized design to investigate the effect on home blood pressure (BP), ambulatory BP, and sleep. The hypertensive patients were allocated into the aroma massage group (n = 28), the placebo group (n = 28), and the no-treatment control group (n = 27). To evaluate the effects of aroma massage, the experimental group received a massage with essential oils prescribed by an aromatherapist once a week and body cream once a day. The placebo group received a massage using artificial fragrance oil once a week and body cream once a day. BP, pulse rate, sleep conditions, and 24-hour ambulatory BP were monitored before and after the experiment. There was a significant difference in home systolic blood pressure (SBP) (F = 6.71, P = 0.002) between groups after intervention. There was also a significant difference in SBP (F = 13.34, P = 0.001) and diastolic blood pressure (DBP) (F = 8.46, P = 0.005) in the laboratory between aroma massage and placebo groups. In sleep quality, there was a significant difference between groups (F = 6.75, P = 0.002). In conclusion, aroma massage may help improve patient quality of life and maintain health as a nursing intervention in daily life.
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Grandner MA, Sands-Lincoln MR, Pak VM, Garland SN. Sleep duration, cardiovascular disease, and proinflammatory biomarkers. Nat Sci Sleep 2013; 5:93-107. [PMID: 23901303 PMCID: PMC3724567 DOI: 10.2147/nss.s31063] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Habitual sleep duration has been associated with cardiometabolic disease, via several mechanistic pathways, but few have been thoroughly explored. One hypothesis is that short and/or long sleep duration is associated with a proinflammatory state, which could increase risk for cardiovascular and metabolic diseases. This hypothesis has been largely explored in the context of experimental sleep deprivation studies which have attempted to demonstrate changes in proinflammatory markers following acute sleep loss in the laboratory. Despite the controlled environment available in these studies, samples tend to lack generalization to the population at large and acute sleep deprivation may not be a perfect analog for short sleep. To address these limitations, population based studies have explored associations between proinflammatory markers and habitual sleep duration. This review summarizes what is known from experimental and cross-sectional studies about the association between sleep duration, cardiovascular disease, and proinflammatory biomarkers. First, the association between sleep duration with both morbidity and mortality, with a focus on cardiovascular disease, is reviewed. Then, a brief review of the potential role of proinflammatory markers in cardiovascular disease is presented. The majority of this review details specific findings related to specific molecules, including tumor necrosis factor-α, interleukins-1, -6, and -17, C-reactive protein, coagulation molecules, cellular adhesion molecules, and visfatin. Finally, a discussion of the limitations of current studies and future directions is provided.
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Affiliation(s)
- Michael A Grandner
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, PA, USA ; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, PA, USA
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Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res 2012; 35:1012-8. [PMID: 22763475 DOI: 10.1038/hr.2012.91] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A number of studies have reported that sleep duration might have an important role in the development of hypertension. However, the results have been inconsistent. In this study, a meta-analysis was performed to clarify the association between sleep duration and hypertension risk. PubMed, Embase and ISI web of science databases updated on 28 October 2011 were searched for eligible publications. Pooled odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CI) was calculated using a random- or fixed-effect model. Six prospective (N=9959) and seventeen cross-sectional (N=105432) studies were identified for the data analysis on sleep duration. The results indicated that short sleep duration was associated with an increased risk of prevalent hypertension (OR=1.20, 95% CI: 1.09-1.32, P<0.001), especially among subjects younger than 65 years and females. In addition, short sleep duration was also associated with an increased risk of incident hypertension among subjects younger than 65 years (RR=1.33, 95% CI: 1.11-1.61, P=0.002). Overall, there was a significant association between long sleep duration and the risk of prevalent hypertension (OR=1.11, 95% CI: 1.05-1.17, P<0.001). Further subgroup analysis also suggested a significant association between long sleep duration and the risk of prevalent hypertension among subjects younger than 65 years (OR=1.12, 95% CI: 1.06-1.19, P<0.001). The present meta-analysis indicated that short sleep duration was associated with an increased risk of hypertension in the overall polulation and incident hypertension among subjects younger than 65 years. In addition, long sleep duration might be associated with a risk of prevalent hypertension, especially among subjects younger than 65 years.
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Abstract
INTRODUCTION Sleep is a vital neurochemical process involving sleep-promoting and arousal centers in the brain. Insomnia is a pervasive disorder characterized by difficulties in initiating or maintaining or non-refreshing (poor quality) sleep and clinically significant daytime distress. Insomnia is more prevalent in women and old age and puts sufferers at significant physical and mental health risks. This review summarizes published data on the current and emerging insomnia drug classes, rationale for development and associated risks/benefits. (Summary of Product Characteristics and Medline search on "hypnotic" or specific drug names and "Insomnia"). AREAS COVERED GABA(A) receptor modulators facilitate sleep onset and some improve maintenance but increase risk of dependence, memory, cognitive and psychomotor impairments, falls, accidents and mortality. Melatonin receptor agonists improve quality of sleep and/or sleep onset but response may develop over several days. They have more benign safety profiles and are indicated for milder insomnia, longer usage and (prolonged release melatonin) older patients. Histamine H-1 receptor antagonists improve sleep maintenance but their effects on cognition, memory and falls remain to be demonstrated. Late-stage pipeline orexin OX1/OX2 and serotonin 5HT2A receptor antagonists may hold the potential to address several unmet needs in insomnia pharmacotherapy but safety issues cast some doubts over their future. EXPERT OPINION Current and new insomnia drugs in the pipeline target different sleep regulating mechanisms and symptoms and have different tolerability profiles. Drug selection would ideally be based on improvement in the quality of patients' sleep, overall quality of life and functional status weighed against risk to the individual and public health.
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Affiliation(s)
- Nava Zisapel
- Tel Aviv University, Department of Neurobiology, The George S. Wise Faculty of Life Sciences and Neurim Pharmaceuticals, Tel Aviv 69978, Israel.
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Walia H, Strohl K, Koo B, Seicean A, Seicean S. Are sleep symptoms predictors of resistant hypertension in a population-based sample? Findings from the National Health and Nutritional Examination Survey. J Clin Hypertens (Greenwich) 2012; 14:530-6. [PMID: 22863161 DOI: 10.1111/j.1751-7176.2012.00646.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to test the association of self-reported sleep symptoms to those identified with severe hypertension in a nationally representative sample of adults. Self-reported and study-measured health and sleep characteristics were collected by the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008. Of 10,526 individuals with completed sleep surveys participating in the study, the authors identified 379 patients with severe hypertension defined as those treated with ≥ 3 antihypertensive medications including a diuretic; 110 of these had resistant hypertension (RHTN) despite therapy, while 269 were controlled for severe hypertension (CSHTN). Patients with RHTN were more likely to be married, less educated, smoke, and self-report unsatisfactory health and diabetes when compared with patients with CSHTN. Multivariate analyses showed that poorly controlled diabetes (glycated hemoglobin >7%) was the strongest predictor of RHTN (odds ratio, 3.0; 95% confidence interval, 1.2-7.9). Unsatisfactory health (odds ratio, 1.7; 95% confidence interval, 1.7-2.7) was also associated with RHTN. Poorly controlled diabetes and self-reported unsatisfactory heath showed significant association with RHTN. Contrary to expectations, there was no significant association between self-reported snoring/snorting and RHTN, when other factors were examined. The association between poorly controlled diabetes and RHTN warrants further emphasis on strict control of diabetes in these individuals.
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Affiliation(s)
- Harneet Walia
- Department of Pulmonary, Critical Care and Sleep Medicine, University Hospitals, Case Medical Center, Cleveland, OH, USA.
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Lemoine P, Zisapel N. Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia. Expert Opin Pharmacother 2012; 13:895-905. [DOI: 10.1517/14656566.2012.667076] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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