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Kim Y, Mattos MK, Esquivel JH, Davis EM, Logan J. Sleep and blood pressure variability: A systematic literature review. Heart Lung 2024; 68:323-336. [PMID: 39217647 DOI: 10.1016/j.hrtlng.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Blood pressure variability (BPV) is a prognostic marker of cardiovascular disease (CVD). Sleep is recognized as a significant risk factor for CVD; however, little is known about the relationship between sleep characteristics and BPV. OBJECTIVE In this systematic review, we aimed to (1) describe methods used to measure BPV and sleep and (2) describe the current evidence in the literature on the association between sleep and BPV. METHODS A systematic search was conducted using the search terms "sleep" AND ("blood pressure variability" OR "ambulatory blood pressure monitor") in CINAHL, PubMed, Web of Science, and PsycINFO databases. RESULTS Twenty-two studies were included in this systematic review. Sleep was measured using various methods, including polysomnography, actigraphy, sleep diaries, and questionnaires, while BPV was measured over various time intervals using different monitoring devices such as a beat-to-beat blood pressure (BP) monitoring device, a 24-h ambulatory BP monitor, or an automatic upper arm BP monitor. The studies demonstrated mixed results on the associations between sleep parameters (sleep quality, architecture, and duration) and increased BPV. CONCLUSIONS Although the mechanisms that explain the relationship between sleep and BPV are still unclear, accumulating evidence suggests potential associations between increased BPV with poor sleep quality and longer sleep duration. Given the recent development of sleep and BP monitoring technologies, further research is warranted to assess sleep and BPV under free-living conditions. Such studies will advance our understanding of complex interactions between sleep and CVD risk.
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Affiliation(s)
- Yeonsu Kim
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Meghan Kathleen Mattos
- University of Virginia School of Nursing, 5012 McLeod Hall, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Jill Howie Esquivel
- University of California San Francisco School of Nursing, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Eric M Davis
- Department of Medicine, University of Virginia, 1222 Jefferson Park Ave, Charlottesville, VA, 22903, USA
| | - Jeongok Logan
- University of Virginia School of Nursing, 4011 McLeod Hall, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
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Tobushi T, Floras JS. Sleep Apnea, Autonomic Disturbances, and Blood Pressure Variability. Hypertension 2024; 81:1837-1844. [PMID: 38957967 PMCID: PMC11319079 DOI: 10.1161/hypertensionaha.124.20433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Augmented blood pressure variability has emerged as a quantity predictive of adverse cardiovascular outcomes. Among the range of intrinsic and extrinsic factors shown to increase night-time, circadian, short-term, and long-term blood pressure variations, the presence and severity of obstructive sleep apnea have emerged as one of the most prevalent and potent. Obstructive sleep apnea alters acutely the normal nocturnal equilibrium between sympathetic and parasympathetic tone, magnifying nocturnal blood pressure oscillations, and induces sustained autonomic aftereffects with the capacity to amplify short-term and intersessional blood pressure variabilities. The object of this brief review is to synthesize the current understanding of the potential interrelations between obstructive sleep apnea, the acute and sustained autonomic disturbances that it elicits, and beat-to-beat blood pressure fluctuation during sleep, nocturnal dipping status, and day-to-day blood pressure variability and the consequences of these perturbations for cardiovascular risk.
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Affiliation(s)
- Tomoyuki Tobushi
- University Health Network and Sinai Health Division of Cardiology, Toronto General Hospital Research Institute, and Lunenfeld-Tanenbaum Research Institute, Faculty of Medicine, University of Toronto, ON, Canada (T.T., J.S.F.)
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan (T.T.)
| | - John S. Floras
- University Health Network and Sinai Health Division of Cardiology, Toronto General Hospital Research Institute, and Lunenfeld-Tanenbaum Research Institute, Faculty of Medicine, University of Toronto, ON, Canada (T.T., J.S.F.)
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Mancia G, Schumacher H, Böhm M, Grassi G, Teo KK, Mahfoud F, Parati G, Redon J, Yusuf S. Impact of seasonal blood pressure changes on visit-to-visit blood pressure variability and related cardiovascular outcomes. J Hypertens 2024; 42:1269-1281. [PMID: 38690947 PMCID: PMC11198955 DOI: 10.1097/hjh.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability associates with an increased risk of cardiovascular events. We investigated the role of seasonal BP modifications on the magnitude of BP variability and its impact on cardiovascular risk. METHODS In 25 390 patients included in the ONTARGET and TRANSCEND trials, the on-treatment systolic (S) BP values obtained by five visits during the first two years of the trials were grouped according to the month in which they were obtained. SBP differences between winter and summer months were calculated for BP variability quintiles (Qs), as quantified by the coefficient of variation (CV) of on-treatment mean SBP from the five visits. The relationship of BP variability with the risk of cardiovascular events and mortality was assessed by the Cox regression model. RESULTS SBP was approximately 4 mmHg lower in summer than in winter regardless of confounders. Winter/summer SBP differences contributed significantly to each SBP-CV quintile. Increase of SBP-CV from Q1 to Q5 was associated with a progressive increase in the adjusted hazard ratio (HR) of the primary endpoint of the trials, i.e. morbid and fatal cardiovascular events. This association was even stronger after removal of the effect of seasonality from the calculation of SBP-CV. A similar trend was observed for secondary endpoints. CONCLUSIONS Winter/summer SBP differences significantly contribute to visit-to-visit BP variability. However, this contribution does not participate in the adverse prognostic significance of visit-to-visit BP variations, which seems to be more evident after removal of the BP effects of seasonality from visit-to-visit BP variations.
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Affiliation(s)
| | | | - Michael Böhm
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Josep Redon
- Department of Medicine, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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de Havenon A, Falcone G, Rivier C, Littig L, Petersen N, de Villele P, Prabhakaran S, Kimberly WT, Mistry EA, Sheth K. Impact of sleep quality and physical activity on blood pressure variability. PLoS One 2024; 19:e0301631. [PMID: 38625967 PMCID: PMC11020843 DOI: 10.1371/journal.pone.0301631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/19/2024] [Indexed: 04/18/2024] Open
Abstract
Increased blood pressure variability (BPV) is linked to cardiovascular disease and mortality, yet few modifiable BPV risk factors are known. We aimed to assess the relationship between sleep quality and activity level on longitudinal BPV in a cohort of community-dwelling adults (age ≥18) from 17 countries. Using Withings home measurement devices, we examined sleep quality and physical activity over one year, operationalized as mean daily step count and number of sleep interruptions, both transformed into tertiles. The primary study outcome was high BPV, defined as the top tertile of systolic blood pressure standard deviation. Our cohort comprised 29,375 individuals (mean age = 58.6 years) with 127.8±90.1 mean days of measurements. After adjusting for age, gender, country, body mass index, measurement days, mean blood pressure, and total time in bed, the odds ratio of having high BPV for those in the top tertile of sleep interruptions (poor sleep) was 1.37 (95% CI, 1.28-1.47) and 1.44 (95% CI, 1.35-1.54) for those in the lowest tertile of step count (physically inactive). Combining these exposures revealed a significant excess relative risk of 0.20 (95% CI, 0.04-0.35, p = 0.012), confirming their super-additive effect. Comparing individuals with the worst exposure status (lowest step count and highest sleep interruptions, n = 2,690) to those with the most optimal status (highest step count and lowest sleep interruptions, n = 3,531) yielded an odds ratio of 2.01 (95% CI, 1.80-2.25) for high BPV. Our findings demonstrate that poor sleep quality and physical inactivity are associated with increased BPV both independently and super-additively.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
| | - Guido Falcone
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
| | - Cyprien Rivier
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
| | - Lauren Littig
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
| | - Nils Petersen
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
| | | | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, IL, United States of America
| | - William T. Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Eva A. Mistry
- Department of Neurology, University of Cincinnati, Cincinnati, OH, United States of America
| | - Kevin Sheth
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States of America
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Kanclerska J, Szymańska-Chabowska A, Poręba R, Michałek-Zrąbkowska M, Lachowicz G, Mazur G, Martynowicz H. A Systematic Review of Publications on the Associations Between Sleep Architecture and Arterial Hypertension. Med Sci Monit 2023; 29:e941066. [PMID: 37665688 PMCID: PMC10487188 DOI: 10.12659/msm.941066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023] Open
Abstract
Sleep research has garnered substantial interest among scientists owing to its correlation with various diseases, particularly elevated blood pressure observed in patients with obstructive sleep apnea. This systematic review aims to identify and analyze publications exploring the associations between sleep architecture and arterial hypertension. A comprehensive search of PubMed (MEDLINE), Scopus, and Embase databases yielded 111 reports, of which 7 manuscripts were included in the review. Four of the studies reported a significant reduction in the duration of the N3 phase of sleep in hypertensive patients, while 2 studies found a statistically significant reduction in the duration of the N2 and rapid eye movement (REM) stages of sleep. Three studies indicated increased sleep fragmentation in hypertensive patients. They showed a longer duration of the N1 stage of sleep, shorter duration of overall sleep time, and an increased apnea-hypopnea index in hypertensive patients. These findings underscore the association between the duration of non-REM/REM sleep stages and elevated BP, providing substantial evidence. Moreover, a notable increase in sleep fragmentation was observed among patients with hypertension. However, further research is warranted to expand and deepen our understanding of this intricate relationship. This systematic review serves as a valuable resource, guiding future investigations and contributing to advancements in the field of sleep and arterial hypertension.
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Melikyan ZA, Kawas CH, Paganini-Hill A, Jiang L, Mander BA, Corrada MM. Self-reported sleep in relation to risk of dementia a quarter of a century later at age 90+: The 90+ Study. Behav Sleep Med 2023; 21:620-632. [PMID: 37540023 PMCID: PMC10403699 DOI: 10.1080/15402002.2022.2148668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine sex-specific associations of sleep duration and napping self-reported at mean age of 69 years (range: 53-81) with risk of incident dementia 24 years later at age 90 +. METHOD Analytic sample included individuals from a population-based study who reported sleep and napping once in the 1980s and 24 years later (range: 16-38) joined The 90+ Study and were evaluated in-person. Those without dementia at baseline of The 90+ Study were prospectively followed. Hazard ratios [HR] and 95% confidence intervals [CI] of dementia risk were estimated by Cox regression. RESULTS Of 574 participants 71% were women, mean age at start of dementia follow-up with The 90+ Study was 93 years (range: 90-102). After 3.3 years (range: 0.4-13.8) of follow-up 47% developed dementia. Higher risk of dementia at age 90+ was seen in women with <6 hours of self-reported sleep per night (adjusted HR = 2.00; 95% CI = 1.15-3.50; p = .01) compared with 8 hours. Lower risk of dementia at 90+ was seen in men with short-to-moderate (<60 minutes) self-reported naps compared with no naps (HR = 0.33; 95% CI = 0.18-0.63; p < .01). CONCLUSIONS Sleep and nap 24 years earlier are important risk factors for dementia after age 90.
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Affiliation(s)
- Zarui A. Melikyan
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Claudia H. Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | | | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Bryce A. Mander
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - María M. Corrada
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
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Tamura K, Uchida K, Ishigami T. An interesting link between quality of sleep and a measure of blood pressure variability. J Clin Hypertens (Greenwich) 2021; 23:331-333. [PMID: 33373081 PMCID: PMC8029662 DOI: 10.1111/jch.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Kouichi Tamura
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kotaro Uchida
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
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