Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample

Abstract

Objective: Epidemiologic data increasingly supports sleep as a determinant of cardiovascular disease risk. Fewer studies have investigated the mechanisms underlying this relationship using objective sleep assessment approaches. Therefore, the aim of this study was to examine associations between daily blood pressure and both objectively assessed sleep duration and efficiency.Methods: A diverse community sample of 300 men and women ages 21-70, enrolled in the North Texas Heart Study, participated in the study. Actigraphy assessed sleep was monitored over 2 consecutive nights with ambulatory blood pressure sampled randomly within 45-min blocks on the first and second day as well as the second night.Results: Overall, sleep duration results paralleled those of sleep efficiency. Individuals with lower sleep efficiency had higher daytime systolic (B=−0.35, SE=0.11, p=.0018, R 2 =0.26) but not diastolic BP (B=−0.043, SE=0.068, p=.52, R 2 =0.17) and higher nighttime BP (systolic: B=−0.37, SE=0.10, p<.001, R 2 =.15; diastolic: B=−0.20, SE=0.059, p<.001, R 2 =.14). Moreover, lower sleep efficiency on one night was associated with higher systolic (B=−0.51, SE=0.11, p<.001, R 2 =0.23) and diastolic BP (B=−0.17, SE=0.065, p=.012, R 2 =.16) the following day. When both sleep duration and efficiency were assessed together, sleep efficiency was associated with daytime systolic BP, while sleep duration was associated with nighttime BP.Conclusions: Lower sleep duration and efficiency are associated with higher daytime systolic BP and higher nighttime BP when assessed separately. When assessed together, sleep duration and

Subjective Poor Sleep Quality is Associated with Higher Blood Pressure and Prevalent Hypertension in General Population Independent of Sleep Disordered Breathing

“…Each domain is given a score of 0 to 3 and then combined for a total score ranging from 0 to 21. Sleep quality is categorized into four groups as very good (PSQI score ≤4), fairly good (5)(6)(7)(8)(9), fairly bad (10)(11)(12)(13)(14) and very bad sleep (≥15). SDB is defined as a No-SAS score ≥8, 33 which is validated in the Chinese population.…”

“…Based on existing literature, only a few studies examined the effects of objectively and subjectively measured sleep quality on BP and yielded inconsistent results. Objectively assessed lower sleep duration and/or efficiency, and poor subjective sleep quality, are associated with higher 24-hour and diurnal systolic BP (SBP) and higher nocturnal BP in various adult community dwellers; [5][6][7][8] nonetheless other studies did not observe a significant association between subjective poor sleep quality and BP. 9,10 In terms of hypertension, current evidence fails to provide conclusive results.…”

Objectively Measured Sleep Characteristics and Incidence of Ischemic Stroke: The Sleep Heart Health Study

“…[7][8][9][10] A growing number of studies investigated the role of objective sleep characteristics on cardiovascular disease and its risk factors based on polysomnography (PSG) and actigraphy. [11][12][13] Objective sleep characteristics such as sleep efficiency (SE), arousal index (ArI), the sleep fragmentation index, the percentage of rapid eye movement (REM sleep %), and the percentage of slow-wave sleep (SWS %) were found to be associated with cardiovascular disease and related risk factors, including hypertension, diabetes mellitus, and metabolic syndrome. [13][14][15][16][17] Von Kanel et al also showed that long wake after sleep onset (WASO) was associated with an increased risk of coronary artery disease.…”

Objective short sleep duration and 24-hour blood pressure

“…Prior studies have demonstrated that older adults, rather than younger adults, report poor sleep quality [ 24 , 25 ]. Poor sleep quality has been associated with high ambulatory BP [ 11 ]. Although there was a high prevalence of self-reported poor sleep quality in our sample, the association between sleep duration and 24-h BP remained statistically significant even after adjustment for self-reported poor sleep quality.…”

“…Importantly, most studies assessed sleep duration via self-report [ 6 , 8 ] which is subject to recall bias compared to objective methods like wrist actigraphy [ 10 ]. Only one study [ 11 ] examined objective sleep duration and ABP among adults, but did not report the association of 24-h BP with sleep. We therefore examined the association between objective sleep duration and 24-h BP in an adult multi-ethnic community sample.…”