Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time

Almeneessier, Aljohara S.; Alshahrani, Mana; Aleissi, Salih; Hammad, Omeima; Olaish, Awad H; BaHammam, Ahmed S.

doi:10.1038/s41598-020-60281-2

Cited by 19 publications

(20 citation statements)

References 37 publications

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“… 25 Almeneessier and coworkers have assessed and estimated BbB BPs from pulse transit time (PTT) using electrocardiography (ECG) and finger photoplethysmography in each section before, during, and after OSA events in a sleep setting. 39 The estimated SBP increased by ∼4 mm Hg in non‐REM and ∼7 mm Hg in REM after OSA events compared with SBP before OSA events. Although this increase may indicate the amplitude of sec‐surge (peak SBP–start SBP) in this study, it might be underestimated compared with that (25.8 mm Hg) calculated from calibrated BbB SBPs.…”

Section: Discussionmentioning

confidence: 90%

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index

Kokubo

Kuwabara

Ota

et al. 2021

J of Clinical Hypertension

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Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec-surge is different between sec-surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non-SA factors (rapid eye movement, micro arousal, etc.), and sec-surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables.The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat-by-beat (BbB) BP, and cuff-oscillometric BP measurement during the night. All patients were included for the analysis comparing sec-surge severity between inducing factors (SA and non-SA factors). There were no significant differences in the number of sec-surges/night between SA-related sec-surges and non-SA-related sec-surges (19.5±26.0 vs. 16.4±29.8 events/night).There were also no significant differences in the peak of sec-surges, defined as the maximum systolic BPs (SBPs) in each sec-surge, between SA-related sec-surges and non-SA-related sec-surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec-surge was significantly and strongly associated with the left ventricular mass index (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (β = −0.04, p = .87). This study suggests that peak of sec-surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.

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Section: Discussionmentioning

confidence: 90%

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index

Kokubo

Kuwabara

Ota

et al. 2021

J of Clinical Hypertension

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“…In this prospective observational study, the data generated formed part of a project to assess REM-predominant OSA. 5,6 In the period between January 2003 and December 2017, all patients (≥ 18-years-old) who consulted the University Sleep Disorders Centre (USDC) at King Saud University and were diagnosed with OSA based on nocturnal PSG were included. Diagnostic daytime sleep studies were excluded because the timing of REM sleep could be coupled to the circadian rhythm.…”

Section: Methodsmentioning

confidence: 99%

“…5 Blood pressure increases following obstructive events during REM and NREM sleep. 6 However, REM sleep has been shown to be accompanied by enhanced sympathetic activity and instability of the cardiovascular system; 6 therefore, theoretically, REM-related OSA may be related to more cardiovascular harmful events than NREM OSA. Recently, findings have pointed to an association between REM-related OSA and increased cardiovascular risk.…”

Section: Introductionmentioning

confidence: 99%

<p>The Associations of Gender, Menopause, Age, and Asthma with REM-Predominant Obstructive Sleep Apnea: A Prospective Observational Study</p>

Bahammam¹,

Alqahtani²,

Aleissi³

et al. 2020

NSS

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The study sought to assess demographics, clinical features, comorbidities, and polysomnographic features of a large cohort of clinic-based patients with rapid eye movementpredominant obstructive sleep apnea (REM-predominant-OSA) in both genders, while assessing the relationship between REM-predominant OSA in one hand and menopausal status and age on the other. Methods: This prospective observational study was conducted between January 2003 and December 2017. REM-predominant OSA diagnostic criteria included an AHI of ≥5/h, with REM-AHI/non-REM-AHI of >2, a non-REM-AHI of <15/h, and a minimum of 15 min of REM sleep. Patients who had an AHI>5 events/h and did not meet the criteria for REMpredominant OSA were included in the non-stage-specific OSA group (NSS). Results: The study consisted of 1346 men and 823 women (total=2169). REM-predominant OSA was diagnosed in 17% (n=369). The prevalence of REM-predominant OSA in women was 25% compared with 12% in men. Several independent associations of REMpredominant OSA were identified in the whole group, including age (OR: 0.97 [0.95-0.98], p<0.01), female sex (OR: 6.95 [4.86-9.93], p>0.01), REM sleep duration (min) (OR: 1.02 [1.02-1.03], < 0.01), and time with SpO2 <90% (mins) (OR: 0.97 [0.95-0.99], < 0.01), hypertension (OR:0.67 [0.45-0.99], 0.04) and asthma (OR: 2.19 [1.56-3.07], < 0.01). The prevalence of REM-predominant OSA in premenopausal and postmenopausal women was 35% and 18.6% (p< 0.01), respectively. Among women, age was an independent correlate (OR: 0.97 [0.94-0.99], p=0.03; however, menopausal status was not. Conclusion: REM-predominant OSA is prevalent among clinic-based patients with OSA. A younger age and female sex were independent correlates of REM-predominant OSA. Among women, a younger age but not menopausal status was a correlate of REMpredominant OSA. Asthma was independently associated with REM-predominant OSA.

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“…During sleep, BP was indirectly determined via a pulse-transit-time (PTT), which is validated-method using the DOMINO-Software (DOMINO-2.2.0 provided with the SOMNOscreen-plus, Randersacker, Germany) 18 . We have described the details of the used method in a previous paper 19 . In brief, the noninvasive measurement of BP using the SOMNOscreen plus has been validated following the European Society of Hypertension protocol 18 .…”

Section: Methodsmentioning

confidence: 99%

Blood pressure dipping during REM and non-REM sleep in patients with moderate to severe obstructive sleep apnea

BaHammam

Alshahrani

Aleissi

et al. 2021

Sci Rep

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A limited number of papers have addressed the association between non-dipping-blood pressure (BP) obstructive sleep apnea (OSA), and no study has assessed BP-dipping during rapid eye movement (REM) and non-REM sleep in OSA patients. This study sought to noninvasively assess BP-dipping during REM and non-REM (NREM)-sleep using a beat-by-beat measurement method (pulse-transit-time (PTT)). Thirty consecutive OSA patients (men = 50%) who had not been treated for OSA before and who had > 20-min of REM-sleep were included. During sleep, BP was indirectly determined via PTT. Patients were divided into dippers and non-dippers based on the average systolic-BP during REM and NREM-sleep. The studied group had a a median age of 50 (42–58.5) years and a body mass index of 33.8 (27.6–37.5) kg/m2. The median AHI of the study group was 32.6 (20.1–58.1) events/h (range: 7–124), and 89% of them had moderate-to-severe OSA. The prevalence of non-dippers during REM-sleep was 93.3%, and during NREM-sleep was 80%. During NREM sleep, non-dippers had a higher waist circumference and waist-hip-ratio, higher severity of OSA, longer-time spent with oxygen saturation < 90%, and a higher mean duration of apnea during REM and NREM-sleep. Severe OSA (AHI ≥ 30) was defined as an independent predictor of non-dipping BP during NREM sleep (OR = 19.5, CI: [1.299–292.75], p-value = 0.03). This short report demonstrated that BP-dipping occurs during REM and NREM-sleep in patients with moderate-to-severe OSA. There was a trend of more severe OSA among the non-dippers during NREM-sleep, and severe OSA was independently correlated with BP non-dipping during NREM sleep.

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Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time

Cited by 19 publications

References 37 publications

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index

Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index

<p>The Associations of Gender, Menopause, Age, and Asthma with REM-Predominant Obstructive Sleep Apnea: A Prospective Observational Study</p>

Blood pressure dipping during REM and non-REM sleep in patients with moderate to severe obstructive sleep apnea

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