Blood pressure dipping and sleep quality in the Wisconsin Sleep Cohort

Abstract

Aims: Nondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample. Methods: A subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately. Results: In cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3–3.5) for 1-h longer waking after sleep onset, 2.1 (1.1–5.1) for 7–8 h total sleep time, and 3.7 (1.3–10.7) for at least 8-h total sleep time (compared with total sleep time 6–7 h), and 1.9 (1.1–3.4) for sleep efficiency less than 0.8, respectively. Conclusion: Clinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.

Relationship of Non-Dipper and Reverse-Dipper Pattern with Sleep Quality in Normotensive Patients

“…To the best of our knowledge, the findings of this study support some previous studies. [17][18][19] As a result of our study, we found that especially in ND and RD groups, there was increased sleep disturbance and insomnia and decreased sleep time.…”

“…22 In the study of Lyu et al evaluating 368 normotensive individuals between the ages of 30-60, it was found that clinical features of insomnia and poor sleep quality are associated with non-dipping BP. 18 In Lyu et al 's study using the Wisconsin Sleep Cohort, 18 polysomnography and ABPM readings of all participants were obtained at random intervals, every 15-20 minutes during wakefulness, and every 30 minutes during sleep. In our study, ABPM measurements were obtained during wakefulness and sleep every 30 minutes.…”

“…Respondents are asked to rate, on a 4-point scale (0-3), their usual chances of dozing off or falling asleep while engaged in eight different activities. An ESS >10 points suggest the presence of excessive daytime sleepiness and results were evaluated in 5 groups [lower normal (0-5), higher normal (6-10), mild excessive (11)(12), moderate excessive (13)(14)(15), and severe excessive sleepiness (16)(17)(18)(19)(20)(21)(22)(23)(24)]. 12 ISI is a seven-item questionnaire designed as a short screening tool for insomnia.…”

“…A 5-point Likert scale is used to rate each item (for example, 0=no problem; 4=very serious problem), giving a total score ranging from 0 to 28. The total score is interpreted as follows: lack of insomnia (0-7); subthreshold insomnia (8)(9)(10)(11)(12)(13)(14); moderate insomnia (15)(16)(17)(18)(19)(20)(21); and severe insomnia (22-28). 13 PSQI is a self-report that evaluates sleep quality in 1 month period.…”

Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men

“…By utilizing 24-ABPM measurements and objective and subjective markers of insomnia, a separate study involving 502 participants aged 30-60 years from the Wisconsin sleep cohort documented significant cross-sectional associations of subjective and objective sleep quality markers with BP non-dipping (including both systolic and diastolic non-dipping). Additionally, the same study showed in longitudinal analyses that longer wake after sleep onset, longer total sleep time and lower sleep efficiency were associated with higher risk of systolic non-dipping 19 . In contrast, our study did not find differences in systolic dipping between older men with and without insomnia symptoms.…”