Cerebral Hemodynamics in Sleep Apnea and Actigraphy-Determined Sleep Duration in a Sample of the Hispanic Community Health Study/ Study of Latinos

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20-1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09-1.32] and 9 % [PR: 1.09; CI: 1.00-1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

Nonlinear associations between sleep duration and the risks of all-cause and cardiovascular mortality among the general adult population: a long-term cohort study

Objective

This study aims to investigate the correlation between sleep duration and all-cause and cardiovascular mortality in the general population.

Methods

A total of 26,977 participants aged ≥18 years were included in the analysis from the National Health and Nutrition Examination Survey (NHANES) database covering the period from 2005 to 2014. Data on cardiovascular and all-cause deaths were collected until December 2019. Sleep duration was assessed using a structured questionnaire, and participants were categorized into five groups based on their reported sleep duration (≤5, 6, 7, 8, or ≥9 h). Kaplan-Meier survival curves were employed to examine the mortality rates across different sleep duration groups. Multivariate Cox regression models were utilized to explore the association between sleep duration and mortality. Additionally, a restricted cubic spline regression model was employed to identify the non-linear relationship between sleep duration and all-cause and cardiovascular mortality.

Results

The average age of participants was 46.23 ± 18.48 years, with 49.9% of the subjects being male. Over a median follow-up period of 9.42 years, 3,153 (11.7%) participants died from all-cause mortality, among which 819 (3.0%) were attributed to cardiovascular causes. The groups with sleep durations of ≥9 and ≤5 h exhibited the lowest cumulative survival rates for all-cause mortality and cardiovascular mortality, respectively. When using a sleep duration of 7 h as the reference, the hazard ratios (with 95% confidence intervals) for all-cause mortality were 1.28 (1.14-1.44) for ≤5 h, 1.10 (0.98-1.23) for 6 h, 1.21 (1.10-1.34) for 8 h, and 1.53 (1.35-1.73) for ≥9 h. The hazard ratios (with 95% confidence intervals) for cardiovascular mortality were 1.32 (1.04-1.67) for ≤5 h, 1.22 (0.97-1.53) for 6 h, 1.29 (1.05-1.59) for 8 h, and 1.74 (1.37-2.21) for ≥9 h. A U-shaped non-linear relationship between sleep duration and all-cause and cardiovascular mortality was observed, with inflection point thresholds at 7.32 and 7.04 h, respectively.

Conclusion

The findings suggest that the risk of all-cause and cardiovascular mortality is minimized when sleep duration is approximately 7 h.

Retinal vascular fractal dimension measurements in patients with obstructive sleep apnea syndrome: a retrospective case-control study

STUDY OBJECTIVES

We performed a case-control study to investigate the correlation between the apnea-hypopnea index (AHI) and the retinal vascular fractal dimension (FD).

METHODS

We selected 527 individuals who underwent polysomnography during health checkups at the Huadong Sanatorium from January to December 2021 as the study population, of whom 468 were included and 59 were excluded. All participants underwent a detailed health examination, including medical history assessment, physical examination, assessment of lifestyle factors, fundus photography, and laboratory examinations. The retinal vasculature was quantitatively assessed using Singapore I Vessel Assessment (SIVA) software. The relationship between the AHI and the retinal vessel quantitative was examined by multiple linear regression analyses and restricted cubic spline.

RESULTS

Among the 468 studied individuals, the average age was 51.51 (43-58) years, with 369 (78.85%) men and 99 (21.15%) women. According to the AHI indicator, 355 individuals were diagnosed with obstructive sleep apnea (OSA) syndrome, with an average AHI of 17.00 (9.200-30.130) events/h; 113 individuals were classified as controls, with an average AHI of 2.13 (0.88-3.63) events/h. In multiple linear regression, following varying degrees of adjustment for confounding factors, FD was reduced by 0.013 (P = .012; 95% confidence interval [CI]: -0.024 to -0.003), FD arteriole (FDa) was reduced by 0.013 (P = .019; 95% CI: -0.024 to -0.002), and FD venule (FDv) was reduced by 0.014 (P = .08; 95% CI: -0.024 to -0.004) in the high-AHI group compared with the low-AHI group. All tests for trend P values were < .05. The restricted cubic spline in the overall OSA population and the individuals without diabetes revealed a U-shaped pattern of decreasing, then increasing, FD, FDa, and FDv with a rising AHI. In the OSA individual with diabetes, FD, FDa, and FDv gradually decreased with increasing AHI.

CONCLUSIONS

The FD is associated with AHI in OSA individuals. The link between AHI and FD varied for OSA individuals with and without diabetes.

CITATION

Wang J, Chen T, Qi X, Li Y, Yang X, Meng X. Retinal vascular fractal dimension measurements in patients with obstructive sleep apnea syndrome: a retrospective case-control study. J Clin Sleep Med. 2023;19(3):479-490.

Association between Sleep Duration and Hypertension among Adults in Southwest China

Objective:

This study aimed to evaluate the association between sleep duration and hypertension among adults in southwest China.

Methods:

Baseline variables were collected from a representative sample of 20,053 adults aged 23–98 years in southwest China who received physical examinations from January 2019 to December 2020. All participants were categorized into either a hypertension group or a non-hypertension group. Sleep duration was classified as short (<6 h/day), normal (6–8 h/day),or long (>8 h/day). Baseline variables were compared between individuals with and without hypertension by rank-sum tests for two independent samples or χ² tests for nonparametric data. Multivariate logistic regression analysis was performed to evaluate the association between sleep duration and hypertension.

Results:

The overall incidence of hypertension was 51.2%. Unadjusted analysis showed that the risk of hypertension was higher in individuals with short (<6h/day) or long (>8h/day) sleep durations compared with those with a normal (6–8 h/day) sleep duration. The risk of hypertension was significantly increased by 30.1% in participants with a long (>8h/day) sleep duration compared with those with a normal (6–8h/day) sleep duration (OR = 1.301, P < 0.010, 95%CI = 1.149–1.475). The risk of hypertension was also increased by 1.1% in participants with a short (<6h/day) sleep duration compared with participants with a normal (6–8h/day) sleep duration, but the difference was not significant (OR = 1.011, P = 0.849, 95%CI = 0.905–1.129). After fully adjusting for confounding factors (model 4), the risk of hypertension was increased significantly (by 25%) in individuals with a short (<6h/day) sleep duration (OR = 1.25, P = 0.02, 95%CI = 1.036–1.508) but not in those with a long (>8h/day) sleep duration (17.5% increase) compared with participants with a normal (6–8h/day) sleep duration (OR = 1.175, P = 0.144, 95%CI = 0.946–1.460).

Conclusion:

The results of this study indicate that a short (<6h/day) sleep duration is related to an increased risk of hypertension, suggesting that sleep helps to protect against hypertension.

Relationship between Sleep and Hypertension: Findings from the NHANES (2007-2014)

Background: To evaluate the association of sleep factors (sleep duration, self-reported trouble sleeping, diagnosed sleep disorder) and combined sleep behaviors with the risk of hypertension. Methods: We analyzed 12,166 adults aged 30–79 years who participated in the 2007–2014 National Health and Nutrition Examination Survey. Sleep duration, self-reported trouble sleeping and sleep disorders were collected using a standardized questionnaire. We included three sleep factors (sleep duration, self-reported trouble sleeping and sleep disorder) to generate an overall sleep score, ranging from 0 to 3. We then defined the sleep pattern as “healthy sleep pattern” (overall sleep score = 3), “intermediate sleep pattern” (overall sleep score = 2), and “poor sleep pattern” (0 ≤ overall sleep score ≤ 1) based on the overall sleep score. The definition of hypertension was based on self-reported antihypertensive medication use or biological measurement (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). We used weighted logistic regression models to investigate the associations between sleep and hypertension. Results: The overall prevalence of hypertension was 37.8%. A short sleep duration (OR = 1.20, 95% CI: 1.08 to 1.33, p = 0.001), self-reported trouble sleeping (OR = 1.45, 95% CI: 1.28 to 1.65, p < 0.001) and sleep disorder (OR = 1.33, 95% CI: 1.07 to 1.66, p = 0.012) were related to the risk of hypertension. Poor sleep patterns were closely correlated with the risk of hypertension (OR = 1.90, 95% CI: 1.62 to 2.24). Conclusions: Participants with poor sleep patterns were associated with an increased risk for hypertension.

Effect of acupuncture on sleep quality and neurological function in stroke patients with sleep apnea syndrome

OBJECTIVE

To investigate the effect of acupuncture on sleep quality and neurological function in stroke patients with sleep apnea syndrome (SAS).

METHODS

In this prospective study, a total of 88 stroke patients with SAS were randomized into two groups: observation group (44 cases; patients received the western medicine treatment combined with acupuncture) and control group (44 cases; patients were given western medicine treatment only). All patients in both groups were treated for three weeks. The clinical efficacy, sleep quality, apnea-hypopnea index (AHI), cognitive function, neuron-specific enolase (NSE) and S100 calcium binding protein β (S100β) levels before and after treatment were compared between patients in the two groups.

RESULTS

Compared with those before treatment, the sleep latency, sleep duration, sleep efficiency and minimal oxygen saturation (SaO_2min) increased, while the longest apnea time and AHI decreased in both groups after treatment. More significant changes were found in the observation group (all P<0.05). After treatment, the overall effective rate in the observation group was higher than that in the control group (P<0.05); serum levels of NSE and S100β in both groups were lower than those before treatment, and the levels of the observation group were lower than those of the control group (all P<0.05); Montreal Cognitive Assessment (MoCA) scores in both groups were higher than those before treatment, and scores of the observation group were higher than those of the control group (all P<0.05).

CONCLUSION

Western medicine treatment combined with acupuncture can significantly relieve the clinical symptoms of stroke patients with SAS and improve sleep quality and neurological function. Therefore, it is worthy of clinical application.

Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment

PURPOSE OF REVIEW

This review aims to discuss the most recent data on sleep disorders and stroke, highlighting relevant findings for the practicing neurologist or health providers who encounter patients with sleep disorders and stroke.

RECENT FINDINGS

Sleep apnea and abnormal sleep duration have the strongest association with stroke risk. Possible mechanisms include non-dipping of blood pressure during sleep, hypoxemia or reoxygenation leading to sympathetic activation, hypertension, atrial fibrillation and impaired cerebral hemodynamics. Treatment studies suggest that continuous positive airway pressure (CPAP) for sleep apnea could improve primary prevention of stroke, but data is equivocal for secondary prevention. However, CPAP could improve functional outcomes after stroke.

SUMMARY

Sleep disorders present an opportunity to improve stroke risk and functional outcomes. However, new strategies are needed to determine the patients at high-risk who would most likely benefit from targeted care. Novel methods for phenotyping sleep disorders could provide personalized stroke care to improve clinical outcomes and public health strategies.