Decreased Slow Wave Sleep Increases Risk of Developing Hypertension in Elderly Men

Fung, Maple M.; Peters, Katherine W.; Redline, Susan; Ziegler, Michael G.; Ancoli‐Israel, Sonia; Barrett‐Connor, Elizabeth; Stone, Katie L.

doi:10.1161/hypertensionaha.111.174409

Cited by 175 publications

(120 citation statements)

References 33 publications

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“…Recently, Fung and coworkers examined 853 community dwelling men aged 75 years and older participating in the Osteoporotic Fractures Men Study (MrOS), and found that total sleep time and other sleep measurements assessed by actigraphy were not associated with incident hypertension. 19 In our cohort of non-insomniac elderly, we found that short sleep duration < 6 h and poor sleep quality, i.e., PSQI > 5, do not affect the presence of HT or diurnal and nocturnal BP values. Moreover, no association was found between age, nocturnal blood pressure values, and reported sleep measurements such as sleep latency and sleep efficiency, apart from subjective total sleep duration.…”

Section: Discussionmentioning

confidence: 63%

“…16 However, in the Gangwisch study of 4,810 participants of the NHANES cohort, a self-reported sleep duration < 5 h per night was associated with a signifi cantly increased risk of developing HT at follow-up in middle-aged subjects, but not in subjects aged > 60 years. 17 Therefore, while many epidemiological studies have suggested a relationship between sleep duration and HT in middleaged insomnia patients, the results are confl icting in the elderly population, with some studies stressing the independent risk of short sleep for HT 13,[18][19][20][21] and other studies fi nding no association. [22][23][24][25][26] The discrepancies among these reports likely stem…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Sforza

Martin

Barthélemy

et al. 2014

Journal of Clinical Sleep Medicine

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Objectives: Sleep duration and sleep quality play important roles in the development of hypertension (HT) in middle-aged subjects, with controversial data in elderly. In this study, we investigated the link between HT and self-reported sleep in non-insomniac elderly subjects. Methods: We examined 500 participants without insomnia complaints aged 72 ± 1 years. An extensive instrumental evaluation was carried out, including 24-h blood pressure (BP) monitoring and an assessment of nocturnal BP dipping. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI). The subjects were stratifi ed into three groups according to sleep duration: short (< 6 h), normal (> 6h to < 8 h), and long (> 8 h) sleepers. A PSQI < 5 defi ned good sleepers (GS, n = 252), and a PSQI > 5 (n = 248) defi ned poor sleepers (PS). Results: PS represented 50% of the subjects, more frequently females. Compared to GS, PS did not differ in terms of HT, BP, barorefl ex sensitivity (BRS), and BP dipping. Short, normal, and long sleepers accounted for 28%, 42%, and 30% of subjects, with HT, BP values, BRS, and gender not differing between groups. No relationship was found between nocturnal BP values and self-reported sleep measures. Logistic regression analysis indicated that neither sleep duration nor sleep quality predicts the prevalence of HT, the body mass index being the only factor affecting this association. Clinical Trial Registration: ClinicalTrials.gov identifi ers NCT00759304 and NCT00766584 Conclusions: In a sample of non-insomniac elderly subjects, neither sleep duration nor sleep quality affected the prevalence of HT. These data argue against a relationship between selfreported sleep duration and quality and HT in elderly without insomnia. Keywords: hypertension, blood pressure, elderly, sleep duration, sleep quality, Pittsburgh Sleep Quality Index questionnaire Citation: Sforza E, Saint Martin M, Barthelemy JC, Roche F. Association of self-reported sleep and hypertension in non-insomniac elderly subjects. J Clin Sleep Med 2014;10(9):965-971.

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Section: Discussionmentioning

confidence: 63%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Sforza

Martin

Barthélemy

et al. 2014

Journal of Clinical Sleep Medicine

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“…Specifically, REM sleep expression was found to be inversely related to central obesity, and SWS expression was also found to be inversely related to BMI and incident hypertension. [35][36][37] PSG measures are important to document in obesity and OSA studies, as work done by our lab 38 and others 39 indicates a role of sleep architecture in influencing metabolism and body weight regulation. The percentage of SWS and REM sleep was negatively correlated with next-day intakes of fat and carbohydrates when participants were given an ad libitum eating opportunity.…”

Section: Discussionmentioning

confidence: 91%

Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

Shechter

St‐Onge

Kuna

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To determine if weight loss and/or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). Methods: This was a randomized controlled trial including 264 overweight/obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. Results: Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a signifi cant positive association between AHI and stage 1 sleep (p < 0.001), and a signifi cant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a signifi cant positive association with change in body weight (p = 0.009). Conclusions: Compared to control, the ILI did not induce signifi cant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more infl uenced by weight than AHI. S C I E N T I F I C I N V E S T I G A T I O N SO besity, type 2 diabetes (T2D), and obstructive sleep apnea (OSA) are three related disorders which have been demonstrated to co-occur in patients. Indeed, obesity is established as one of the leading risk factors for the development of both T2D and OSA, and a high prevalence (~86.6%) of undiagnosed OSA was found in obese patients with T2D.1 Defi cits in sleep duration and/or quality may be a common link among these three factors. A growing body of both epidemiological and laboratory-based studies supports a role of short sleep duration in the development of obesity.2-4 Sleep curtailment is also associated with increased incidence of T2D as well as defi cits in glucose regulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: A growing body of evidence supports a relationship between sleep and obesity. A long-term weight loss intervention (up to 4 years) has previously been shown to improve the severity of sleep disordered breathing in a group of overweight and obese patients with obstructive sleep apnea (OSA) and type 2 diabetes, although the effects of the structured weight loss program on nocturnal sleep duration and architecture have not yet been explored. Study Impact: Although the weight loss intervention was effective in reducing the severity of OSA over a 4-year period, it did not lead to changes in the various po...

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“…Decreased SWS is associated with a 1.8‐fold increased risk of developing hypertension in elderly men (Fung et al, 2011). The circadian rhythm of BP is blunted in patients with insomnia, even in those who are normotensive (Lanfranchi et al, 2009).…”

Section: Melatonin In the Treatment Of Circadian Rhythm And Sleep Dismentioning

confidence: 99%

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

Zisapel

2018

British J Pharmacology

550

350

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In mammals, a central circadian clock, located in the suprachiasmatic nuclei (SCN) of the hypothalamus, tunes the innate circadian physiological rhythms to the ambient 24 h light–dark cycle to invigorate and optimize the internal temporal order. The SCN‐activated, light‐inhibited production of melatonin conveys the message of darkness to the clock and induces night‐state physiological functions, for example, sleep/wake blood pressure and metabolism. Clinically meaningful effects of melatonin treatment have been demonstrated in placebo‐controlled trials in humans, particularly in disorders associated with diminished or misaligned melatonin rhythms, for example, circadian rhythm‐related sleep disorders, jet lag and shift work, insomnia in children with neurodevelopmental disorders, poor (non‐restorative) sleep quality, non‐dipping nocturnal blood pressure (nocturnal hypertension) and Alzheimer's disease (AD). The diminished production of melatonin at the very early stages of AD, the role of melatonin in the restorative value of sleep (perceived sleep quality) and its sleep‐anticipating effects resulting in attenuated activation of certain brain networks are gaining a new perspective as the role of poor sleep quality in the build‐up of β amyloid, particularly in the precuneus, is unravelled. As a result of the recently discovered relationship between circadian clock, sleep and neurodegeneration, new prospects of using melatonin for early intervention, to promote healthy physical and mental ageing, are of prime interest in view of the emerging link to the aetiology of Alzheimer's disease.Linked ArticlesThis article is part of a themed section on Recent Developments in Research of Melatonin and its Potential Therapeutic Applications. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.16/issuetoc

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Decreased Slow Wave Sleep Increases Risk of Developing Hypertension in Elderly Men

Cited by 175 publications

References 33 publications

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

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