Sleep Disorders in the Older Patient

Efficacy and Safety of Panax ginseng Sprout Extract in Subjective Memory Impairment: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Sprout ginseng extract (ThinkGIN™) manufactured through a smart farm system has been shown to improve memory in preclinical studies. This study conducted a 12-week randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of ThinkGIN™ for improving memory in subjective memory impairment (SMI). Subjects aged 55 to 75 years with SMI participated in this study. A total of 80 subjects who met the inclusion/exclusion criteria were assigned to the ThinkGIN™ group (n = 40, 450 mg ThinkGIN™/day) or a placebo group (n = 40). Efficacy and safety evaluations were conducted before intervention and at 12 weeks after intervention. As a result of 12 weeks of ThinkGIN™ intake, significant differences in SVLT, RCFT, MoCA-K, PSQI-K, and AChE were observed between the two groups. Safety evaluation (AEs, laboratory tests, vital signs, and electrocardiogram) revealed that ThinkGIN™ was safe with no clinically significant changes. Therefore, ThinkGIN™ has the potential to be used as a functional food to improve memory.

Effect of Kami Guibi-tang (KGT) in elderly subjects with insomnia: a study protocol from a single center, randomized, double-blind, placebo-controlled trial

BACKGROUND

The incidence of insomnia increases with age and is related to cognitive function in older adults; therefore, it is important to manage it actively. In this study, we report a protocol for the evaluation of the efficacy and safety of Kami Guibi-tang (KGT), a herbal prescription that has been widely used in East Asia for insomnia, forgetfulness, and depression, in older adults with insomnia.

METHODS

In this single-center, double-blind, randomized controlled trial, 60 older adults with insomnia and subjective cognitive decline will be recruited and randomly assigned to the KGT or placebo group. The KGT group will take KGT granules thrice a day for 12 weeks, whereas the control group will take placebo granules in the same manner. Participants will be assessed for sleep, cognitive function, quality of life, and depression using the Pittsburgh Sleep Quality Index-Korean (PSQI-K), Insomnia Severity Index-Korean (ISI-K), Seoul Neuropsychological Screening Battery-Dement (SNSB-D), 36-item MOS Short Form Survey (SF-36) and Short version of the Geriatric Depression Scale (S-GDS) before and at the end of administration of the investigational product. The PSQI-K, ISI-K, and SF-36 will be further assessed 12 weeks after the end of medication to determine whether the effects on sleep and quality of life are sustained. The PSQI-K total score difference between the two groups at 12 and 24 weeks will be the primary outcome; all other endpoints will be secondary. Safety will be assessed by performing blood tests and electrocardiograms before taking the investigational drug, 6 weeks after taking the drug, and 12 weeks after taking the drug; any adverse events will be observed throughout the study.

DISCUSSION

The protocol will provide a detailed process for a clinical trial to evaluate the efficacy and safety of KGT in elderly patients with insomnia. We will also investigate if changes in cognitive function correlated with improvements in insomnia.

TRIAL REGISTRATION

This trial was registered at CRIS (Clinical Research Information Service) on April 27, 2023 (KCT0008391, version 2.0).  https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24811&search_page=L .

Circadian disruption of hippocampus in an early senescence male mouse model

Age-related cognitive decline and disruptions in circadian rhythms are growing problems as the average human life span increases. Multiple strains of the senescence-accelerated mouse (SAM) show reduced life span, and the SAMP8 strain in particular has been well documented to show cognitive deficits in behavior as well as a bimodal pattern of circadian locomotor activity. However, little is known about circadian regulation within the hippocampus of these strains of mice. Here we test the hypothesis that in this early senescence model, disruption of the molecular circadian clock in SAMP8 animals drives disrupted behavior and physiology. We found normal rhythms in PER2 protein expression in the SCN of SAMP8 animals at 4 months, despite the presence of disrupted wheel-running activity rhythms at this age. Interestingly, a significant rhythm in PER2 expression was not observed in the hippocampus of SAMP8 animals, despite a significant 24-h rhythm in SAMR1 controls. We also examined time-restricted feeding as a potential strategy to rescue disrupted hippocampal plasticity. Time-restricted feeding increased long-term potentiation at Schaffer collateral-CA1 synapses in SAMP8 mice (compared to SAMR1 controls). Overall, we confirm disrupted circadian locomotor rhythms in this early senescence model (as early as 4 months) and discovered that this disruption is not due to arrhythmic PER2 levels in the SCN; however, other extra-SCN circadian oscillators (i.e., hippocampus) are likely impaired with accelerated aging.

Prevalence of Poor Sleep Quality in Patients With Hypertension in China: A Meta-analysis of Comparative Studies and Epidemiological Surveys

OBJECTIVE

This meta-analysis examined the prevalence of poor sleep quality and its associated factors in patients with hypertension in China.

METHODS

Both English (PubMed, PsycINFO, EMBASE) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched. The random-effects model was used to estimate the prevalence of poor sleep quality in Chinese patients with hypertension. The funnel plot and Egger's tests were used to assess publication bias.

RESULTS

The prevalence of poor sleep quality in 24 studies with 13,920 hypertensive patients was 52.5% (95% confidence interval [CI]: 46.1-58.9%). In contrast, the prevalence of poor sleep quality in six studies with 5,610 healthy control subjects was 32.5% (95% CI: 19.0-49.7%). In these studies, compared to healthy controls, the pooled odds ratio (OR) of poor sleep quality was 2.66 (95% CI: 1.80-3.93) for hypertensive patients. Subgroup and meta-regression analyses revealed that patients in hospitals were more likely to have poor sleep quality than patients in the community. Studies with smaller sample size, studies using convenience or consecutive sampling and those published in Chinese reported higher prevalence of poor sleep quality. Furthermore, poor sleep quality was more common in older and male hypertensive patients, while the proportion of poor sleep quality was negatively associated with survey year.

CONCLUSION

Appropriate strategies for screening, prevention, and treatment of poor sleep quality in this population should be developed.

The prevalence of insomnia and its risk factors among older adults in a city in Turkey's Aegean Region

AIM

Experienced by many older adults, insomnia is a significant public health problem that requires the attention of health-care professionals and researchers. This study aimed to identify insomnia and its risk factors among community-dwelling older adults.

METHODS

This cross-sectional study was conducted in Denizli, Turkey. The study sample consisted of 360 elderly individuals aged 60 years and older who were admitted to one of six family health centres for any reason between 29 March 2016 and 17 June 2016. Data were collected by using a descriptive form for the elderly and the Insomnia Severity Index. The χ² test was used to compare independent variables and insomnia status. Logistic regression analysis was used for the variables that were found to be significant at the end of the single-variable analysis.

RESULTS

The mean age of the subjects, all of whom lived at home, was 69.52 ± 8.36 years. Insomnia was quite common among them (51%), and its severity was low (8.51 ± 5.56). At the end of logistic regression analysis, a moderate perception of health (OR = 10.859, 95%CI: 3.532-33.385) and the number of medications used (OR = 3.326, 95%CI: 1.014-10.907) were identified as risk factors for insomnia.

CONCLUSION

Based on the results of this study, we can state that insomnia is common among older adults. Therefore, older adults who are admitted to health-care institutions should be evaluated for insomnia. Factors identified as affecting insomnia were health perception and the number of medications used. Given that health perception and polypharmacy are associated with chronic disease management, helping the elderly to effectively manage chronic diseases may alleviate insomnia.

Association between Sleep Patterns and Health in Families with Exceptional Longevity

BACKGROUND

Sleep patterns such as longer sleep duration or napping are associated with poor health outcomes. Although centenarians and their offspring demonstrate a delayed onset of age-related diseases, it is not known whether they have healthier sleep patterns or are protected against the negative effects of sleep disturbances.

METHODS

Data on sleep patterns and health history were collected from Ashkenazi Jewish subjects of the Longevity Genes Project using standardized questionnaires. Participants included individuals with exceptional longevity (centenarians) with preserved cognition (n = 348, median age 97 years), their offspring (n = 513, median age 69 years), and controls (n = 199) age-matched to the offspring. Centenarians reported on their sleep patterns at age 70, while the offspring and controls on their current sleep patterns. Biochemical parameters were measured at baseline. Models were adjusted for age, sex, BMI, and use of sleep medication.

RESULTS

The offspring and controls reported similar sleep patterns, with 33% sleeping ≥8 h and 17% napping in each group. At age 70, centenarians were more likely to have slept ≥8 h (55%) and to have napped (28%) compared with offspring and controls, p < 0.01. Among centenarians, no association was noted between sleep patterns and health outcomes. Sleeping for ≥8 h was associated with lower high-density lipoprotein cholesterol levels in the offspring and controls, and with insulin resistance in the offspring, but not with diabetes. Napping was associated with insulin resistance among the controls (p < 0.01), but not the offspring. Controls, but not offspring, who napped were 2.79 times more likely to have one or more of the following diseases: hypertension, myocardial infarction, stroke, or diabetes (OR 2.79, 95% CI 1.08-7.21, p = 0.04).

CONCLUSION

Despite being more likely to exhibit risky sleep patterns at age 70 compared with the offspring and controls, the centenarians were protected from age-related morbidities. The offspring of centenarians did exhibit metabolic disturbances in association with less healthy sleep patterns; however, unlike the controls, they were much less likely to manifest age-related diseases. This suggests that offspring may have inherited resilience genotypes from their centenarian parents that protect them against the harmful effects of sleep disturbances.

Relationship between perceived sleep and polysomnography in older adult patients

BACKGROUND AND AIMS

Aging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep.

OBJECTIVE

The objective of this study was to use polysomnography to compare sleep reported by senior citizens.

METHODS

We selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography.

RESULTS

The results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001).

CONCLUSION

These results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography.

Understanding insomnia in older adults

OBJECTIVE

The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics.

METHODS

This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption.

RESULTS

Of the subjects, 36.1% reported having sleep problems (95% CI: 33.0-39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95% CI: 7.1-11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95% CI: 7.5-11.4) and that of SDMC was 7.0% (95%CI: 5.4-8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43).

CONCLUSIONS

Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome.

The interactive role of chronic medical conditions and sleep disturbance in predicting depressive symptoms among Korean American older adults

OBJECTIVES

This study examined the independent and interactive effects of chronic medical conditions and sleep disturbance on depressive symptomatology. The sample (N = 675) consisted of community-dwelling Korean American older adults, a group that has been found to be particularly high in depressive symptomatology.

METHODS

A hierarchical regression model of depressive symptoms was estimated with an array of predictors: (a) demographic variables, including immigration history, (b) chronic medical conditions, (c) sleep disturbance, and (d) an interaction between chronic medical conditions and sleep disturbance.

RESULTS

After controlling for the effects of demographic variables, both chronic medical conditions and sleep disturbance were identified as independent risk factors for depressive symptoms. Moreover, their interaction was significant, indicating that the coexistence of chronic medical conditions and sleep disturbance was significantly associated with higher levels of depressive symptoms (β = 0.15, p < 0.01).

CONCLUSION

Our findings call attention to sleep hygiene among older individuals with chronic medical conditions and recommend that sleep quality should be closely monitored and assessed by healthcare professionals.

All the wrong moves: a clinical review of restless legs syndrome, periodic limb movements of sleep and wake, and periodic limb movement disorder

Restless legs syndrome, periodic limb movements in sleep, and periodic limb movement disorder are a group of conditions that merit awareness from the medical community. These disorders are commonly encountered yet are often confused and misdiagnosed by health care professionals. It is imperative that health care providers are able to recognize these conditions to accurately diagnose, manage, and appropriately refer patients.

Age-related changes during a paradigm of chronic sleep restriction

Fragmented and restricted sleep is a common problem for the human elderly. There is evidence that aging impairs sleep in animals as well. After sleep deprivation, older animals have less sleep rebound. Despite increasing complaints of reduced time for sleep in contemporary society, few studies have examined chronic sleep restriction protocols in animals. Therefore, the aim of the present study was to evaluate the effects of chronic sleep restriction on the sleep patterns of aged rats. Using the single platform method, 22-month-old male rats were submitted to 18 h of sleep restriction followed by 6 h of total sleep opportunity. The sleep-wake cycles of these rats were recorded for 6h/day throughout the 12-day procedure. The results showed that total sleep time and NREM sleep were reduced during the 12-day sleep restriction period. However, rebound REM sleep was only significant on day 6. A negative rebound was also seen, particularly during the last days of the chronic sleep restriction period. Furthermore, sleep latency and mean wake bout length progressively increased during the protocol. These findings indicate that older rats have an inability to restore their sleep patterns during extended sleep deprivation.

The prevalence of sleep disorders in college students: impact on academic performance

OBJECTIVE

To examine the prevalence of risk for sleep disorders among college students by gender and age, and their associations with grade point average (GPA).

PARTICIPANTS

Participants were 1,845 college students at a large, southeastern public university.

METHODS

A validated sleep disorder questionnaire surveyed sleep data during the 2007-2008 academic year. Students' GPAs were obtained from the office of the registrar.

RESULTS

Twenty-seven percent of students were at risk for at least one sleep disorder. African American and Asian students reported less risk for insomnia and fewer poor sleep practices relative to white and Latino students. Students reported insufficient sleep and a discrepancy between weekday and weekend amount of sleep. Students at risk for sleep disorders were overrepresented among students in academic jeopardy (GPA < 2.0).

CONCLUSIONS

Many college students are at risk for sleep disorders, and those at risk may also be at risk for academic failure.

Protein expression is altered during spontaneous sleep in aged Sprague Dawley rats

Age-related changes in brain function include those affecting learning, memory, and sleep-wakefulness. Sleep-wakefulness is an essential behavior that results from the interaction of multiple brain regions, peptides, and neurotransmitters. The biological function(s) of sleep, however, remains unknown due to a paucity of information available at the cellular level. Aged rats exhibit alterations in the circadian and homeostatic influences associated with sleep-wake regulation. We recently showed that alterations in cortical profiles occur after timed bouts of spontaneous sleep in young rats. Examination of the cellular response to sleep-wake in old rats may thus provide insight(s) into the biological function(s) of sleep. To test this hypothesis, we monitored cortical profiles in the frontal cortex of young and old Sprague-Dawley rats after timed bouts of spontaneous sleep-wake behavior. Proteins were separated by two-dimensional electrophoresis (2-DE), visualized by fluorescent staining, imaged, and analyzed as a function of behavioral state and age. Old rats showed a 6-fold increase in total protein expression, independent of the behavioral state at sacrifice. When analyzed according to age and behavioral state, there was a decrease (approximately 46%) in the number of phospho-spots present during SWS in aged animals. SWS-associated spots present only in old animals were associated with multiple functions including vesicular transport, cell signaling, oxidation state, cytoskeletal support, and energy metabolism. These data suggest that the intracellular response to the signaling associated with spontaneous sleep is affected by age and is consistent with the idea that the ability of sleep to fulfill its function(s) may become diminished with age.

Diagnosis and management of geriatric insomnia: a guide for nurse practitioners

PURPOSE

To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers.

DATA SOURCES

Extensive literature review of the published research articles and textbooks.

CONCLUSIONS

Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults.

IMPLICATIONS FOR PRACTICE

Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management.

INSÔNIA: PREVALÊNCIA E FATORES DE RISCO RELACIONADOS EM POPULAÇÃO DE IDOSOS ACOMPANHADOS EM AMBULATÓRIO

RESUMO Insônia é um problema comum em todos os estágios da vida, mas é particularmente comum após os 65 anos de idade. É definida como uma dificuldade para iniciar o sono ou para se manter dormindo. Os distúrbios do sono nos idosos são comuns e multifatoriais. Vários fatores, incluindo idade avançada, influências psicossociais, doenças clínicas e psiquiátricas e uso de medicações podem estar associados com insônia. Apesar disso, os fatores de risco envolvidos no desenvolvimento de insônia não têm sido completamente identificados. A privação do sono interfere de maneira negativa na qualidade de vida. O objetivo deste trabalho é verificar a prevalência de insônia e de fatores de risco relacionados a esta queixa nos idosos acolhidos no ambulatório de geriatria do NAI (Núcleo de Atenção ao Idoso) da UERJ, em 2005, com 60 anos ou mais, de ambos os sexos. A busca ativa de insônia e sua correta avaliação são passos fundamentais na avaliação geriátrica.

Sleep Disturbances and Falls in Older People

BACKGROUND

Sleep disturbances are common in older people and may contribute to risk of falling.

METHODS

Cross-sectional studies were performed in hostels and with an Internet-based survey. Questionnaires on falls and sleep disturbances were undertaken with clinical measures of cognition, mobility, blood pressure, and vision in the participants in hostels.

RESULTS

There were 150 participants in hostels (mean age 81 +/- 8 years) and 150 respondents to the Internet survey (mean age 70 +/- 5 years). Sleep disturbances were reported by most participants in both the hostel and Internet studies. In hostel participants, falls were associated with poor sleep quality (odds ratio = 4.5, 95% confidence interval, 1.9-12.2; p =.002) and number of nocturnal awakenings (2.5 +/- 1.5 vs 2.0 +/- 1.4, p =.04). Other risk factors for falls in these persons included Geriatric Depression Scale score, pain, Timed Get Up and Go Test score, and the use of diuretics. In the Internet respondents, risk factors for falls included poor health rating and the use of spectacles, bifocals, and walking aids; fewer falls were reported by those participants without any sleep disturbances.

CONCLUSIONS

Sleep disturbances are common in older people and are associated with their risk of falling. Internet-based surveys may be a useful adjunct method for research in older people.

Loss of responsiveness to melatonin in the aging mouse suprachiasmatic nucleus

Melatonin modulates circadian rhythms via the hypothalamic suprachiasmatic nucleus (SCN). One of the most robust assays for SCN melatonin receptor activation in mice is the inhibition of PACAP-induced phosphorylation of the transcription factor Ca(2+)/cAMP responsive element binding protein (CREB). To assess the effect of aging on responsiveness to melatonin, SCN slices from mice of different ages were prepared and treated with PACAP alone or PACAP plus melatonin. CREB phosphorylation state was assessed by immunohistochemistry. In SCN slices from young (2-4-month-old) mice, melatonin reduced the level of phospho-CREB immunoreactivity following PACAP treatment in a dose-dependent manner. In SCN slices from aged mice (19-22 months of age), PACAP alone induced comparable levels of phospho-CREB, but melatonin treatment failed to inhibit the PACAP-induced CREB phosphorylation. The results indicate an age-related loss of sensitivity to melatonin in the SCN. The findings are discussed in the context of the impact of endogenous and exogenous melatonin on sleep in elderly humans.

Functional status in the elderly with insomnia

BACKGROUND

Insomnia causes psychological distress in the elderly. Besides primary insomnia (PI), illness, medications and psychosocial factors contribute to development of sleep disorders. Although elderly insomniacs usually complain of poorer daytime functioning, it is unknown whether the disorder affects capacity to carry out activities.

OBJECTIVE

To assess the relationship in the elderly between PI, level of physical functioning, depression and anxiety symptoms, state of psychological well-being and consumption of psychopharmaceuticals.

DESIGN

Cross-sectional, observational study.

SETTING

Populational.

SUBJECTS

About 424 non-institutionalized elderly patients.

METHODS

Subjects were interviewed at public Health Centres or at home. They were considered to have PI if DSM-IV criteria were met. The remaining variables measured were: depression and anxiety symptoms (The Goldberg's Depression and Anxiety Scale), cognitive state (Short Portable Mental Status Questionnaire), physical functioning (The Katz Index and the Instrumental Activities of Daily Living Scale), life satisfaction (The Philadelphia Geriatric Center Morale Scale), health problems, consumption of pharmaceuticals and sociodemographic variables.

RESULTS

About 34.2% of the elderly admitted to having problems with sleep, but only 20.3% (CI: 95%: 16.5-24.1) fulfilled the criteria for PI. The existence of an anxiety disorder, a score below the 50th percentile on The Philadelphia Geriatric Center Morale Scale (lower life satisfaction) and consumption of psychopharmaceuticals were variables associated with insomnia. Amongst the most common illnesses reported, only diabetes appeared with significantly higher frequency in the elderly with insomnia (24.4% vs. 14.7%) (p < 0.05). No statistically significant association was found between insomnia and level of dependence in carrying out basic or instrumental activities.

CONCLUSIONS

Approximately one fifth of the non-institutionalized elderly meet the criteria for PI. Those affected present a poorer state of psychological and social well-being, although level of autonomy for conducting basic and instrumental activities does not appear to be modified by the disorder. The existence of an anxiety disorder, low life satisfaction and consumption of psychopharmaceuticals constitute variables associated with PI in the population we studied.

Nondipping blood pressure patterns among individuals with essential hypertension: a review of the literature

BACKGROUND

Researchers have discovered that blood pressure (BP) varies in a diurnal manner throughout a 24-hour period, being higher during the day and lower at night. Most people have a dipping BP pattern characterized by a nighttime BP that is 10-20% lower than their daytime BP. Individuals who experience a less than 10% reduction in nighttime BP are described as having a nondipping BP pattern. Although controversial, there is a growing body of evidence suggesting that a nondipping BP pattern is associated with a greater risk of target organ damage among individuals with essential hypertension.

AIM

To review the literature on the most common factors associated with nondipping BP patterns among individuals with essential hypertension.

METHODS

CINAHL (1982-March 2006), PubMed (1950-March 2006) and Cochrane Library (1966-March 2006) databases were searched using the keywords: dipper, dipping, nondipper, nondipping, ambulatory blood pressure monitoring, ABPM, hypertension, essential hypertension, high blood pressure, blood pressure, nocturnal blood pressure, nighttime blood pressure, diurnal blood pressure, and blood pressure patterns. Published studies, abstracts, dissertations as well as the reference lists of retrieved articles were reviewed. Studies were included if they involved subjects with only treated or untreated essential hypertension or those with samples of both nomotensive and treated or untreated essential hypertensive individuals. Additionally, studies needed to evaluate 24-hour, daytime and nighttime BP patterns.

RESULTS

There is some evidence to suggest advanced age, African-American ethnicity, female sex, postmenopausal status, sodium sensitivity, sleep apnea, sleep quality, anger, hostility, depression, stress, social support, and socioeconomic status have an association with nondipping BP patterns.

CONCLUSION

Knowledge of the potential factors associated with an altered nighttime BP pattern is of importance because it can help identify persons at risk for nondipping BP patterns and potential target organ damage. Furthermore, knowledge of these factors associated with a nondipping BP profile will lay the foundation for interventions to prevent/treat alterations in nighttime BP patterns.