Impact of beta-blockers on sleep in patients with mild hypertension: a randomized trial between nebivolol and metoprolol

Yılmaz, Mehmet; Erdem, Alim; Yalta, Kenan; Turgut, Okan Onur; Yılmaz, Ahmet; Tandoğan, İzzet

doi:10.1007/s12325-008-0087-x

Cited by 31 publications

(25 citation statements)

References 18 publications

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“…This study also showed that carvedilol slightly decreased quality of life, whereas nebivolol and bisoprolol had no influence, suggesting that different β-blockers exert different clinically relevant effects. In agreement with this, data from a prospective, randomized, open-label study on the impact of β-blockers on sleep in patients with mild hypertension indicate significant differences between nebivolol versus metoprolol 86. Eligible patients were administered the Pittsburgh Sleep Quality Index questionnaire by a blinded interviewer and were randomized to receive metoprolol or nebivolol.…”

Section: Patient-focused Perspectivesmentioning

confidence: 72%

Nebivolol: impact on cardiac and endothelial function and clinical utility

Toblli

DiGennaro²,

Giani³

et al. 2012

VHRM

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Endothelial dysfunction is a systemic pathological state of the endothelium characterized by a reduction in the bioavailability of vasodilators, essentially nitric oxide, leading to impaired endothelium-dependent vasodilation, as well as disarrangement in vascular wall metabolism and function. One of the key factors in endothelial dysfunction is overproduction of reactive oxygen species which participate in the development of hypertension, atherosclerosis, diabetes, cardiac hypertrophy, heart failure, ischemia-reperfusion injury, and stroke. Because impaired endothelial activity is believed to have a major causal role in the pathophysiology of vascular disease, hypertension, and heart failure, therapeutic agents which modify this condition are of clinical interest. Nebivolol is a third-generation β-blocker with high selectivity for β1-adrenergic receptors and causes vasodilation by interaction with the endothelial L-arginine/ nitric oxide pathway. This dual mechanism of action underscores several hemodynamic qualities of nebivolol, which include reductions in heart rate and blood pressure and improvements in systolic and diastolic function. Although nebivolol reduces blood pressure to a degree similar to that of conventional β-blockers and other types of antihypertensive drugs, it may have advantages in populations with difficult-to-treat hypertension, such as patients with heart failure along with other comorbidities, like diabetes and obesity, and elderly patients in whom nitric oxide-mediated endothelial dysfunction may be more pronounced. Furthermore, recent data indicate that nebivolol appears to be a cost-effective treatment for elderly patients with heart failure compared with standard care. Thus, nebivolol is an effective and well tolerated agent with benefits above those of traditional β-blockers due to its influence on nitric oxide release, which give it singular hemodynamic effects, cardioprotective activity, and a good tolerability profile. This paper reviews the pharmacology structure and properties of nebivolol, focusing on endothelial dysfunction, clinical utility, comparative efficacy, side effects, and quality of life in general with respect to the other antihypertensive agents.

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Section: Patient-focused Perspectivesmentioning

confidence: 72%

Nebivolol: impact on cardiac and endothelial function and clinical utility

Toblli

DiGennaro²,

Giani³

et al. 2012

VHRM

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“…The effects of beta-blockers on sleep are not equivocal. A previous study showed that the use of beta-blockers could positively or negatively affect sleep [22]. A case report by Cicolin et al suggested that ACE inhibitors may contribute to OSA by inducing upper airway inflammation [23].…”

Section: Discussionmentioning

confidence: 99%

Disturbed subjective sleep characteristics in adult patients with long-standing type 1 diabetes mellitus

et al. 2011

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Aims/hypothesisDecreased sleep duration and/or impaired sleep quality negatively influence glucoregulation. The aim of this study was to assess subjective sleep characteristics in patients with type 1 diabetes, to relate sleep characteristics to long-term glycaemic control and to assess possible risk factors for impaired sleep.MethodsWe studied 99 adult patients with type 1 diabetes (55 men, 44 women, duration of diabetes 26.9 ± 1.2 years) and 99 age-, sex- and BMI-matched non-diabetic controls. Subjective sleep characteristics were assessed by validated questionnaires, i.e. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Berlin Questionnaire. Glucoregulation was assessed by HbA1c values. Clinical variables were obtained from medical charts. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS). Peripheral polyneuropathy was assessed by neurological examination and quantitative sensory testing.ResultsOf the patients with type 1 diabetes, 35% had subjective poor sleep quality compared with 20% of the control participants (p = 0.021). A higher proportion of the patients with type 1 diabetes were at increased risk for obstructive sleep apnoea (OSA) (17.2% vs 5.1%, p = 0.012). There was no significant association between individual sleep characteristics and HbA1c values. On logistic regression analysis, the HADS depression score, presence of peripheral polyneuropathy, habitual snoring and other sleep disturbances (e.g. hypoglycaemia) were independently associated with poor sleep quality.Conclusions/interpretationAdult patients with long-standing type 1 diabetes mellitus have disturbed subjective sleep quality and a higher risk for OSA compared with control participants. Subjective sleep disturbances are part of the complex syndrome of long-standing type 1 diabetes.

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“…More patients with HCM used antidepressants and β-blockers than the controls. These two drugs have been associated with sleep disturbances and may have influenced the sleep quality of patients with HCM [33,34]. However, multiple regression analysis showed no independent association between medications and sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality and Quality of Life in Patients with Hypertrophic Cardiomyopathy

Pedrosa¹,

Lima

Drager³

et al. 2010

Cardiology

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Objectives: To evaluate clinical predictors of poor sleep quality and quality of life (QOL) in patients with hypertrophic cardiomyopathy (HCM). Methods: Consecutive stable patients with HCM were evaluated for the risk of obstructive sleep apnea (OSA) by the Berlin Questionnaire, daytime sleepiness by the Epworth Sleepiness Scale, sleep quality by the Pittsburgh Sleep Questionnaire Index and QOL by the Minnesota Living with Heart Failure Questionnaire. Asymptomatic subjects without HCM were used as controls. Results: We studied 84 patients with HCM and 42 controls who were similar with regard to gender (49 vs. 50% males), age [52 (38–62) vs. 47 (33–58) years] and body mass index (27 ± 4 vs. 27 ± 5). HCM diagnosis, high risk for OSA and female gender were independently associated with poor sleep quality in the entire population. Among patients with HCM, poor QOL was independently associated with poor sleep quality, New York Heart Association functional class and diuretic therapy. Conclusion: Poor sleep quality is very common in patients with HCM and may have a negative impact on the QOL, which in turn is an important marker of prognosis in patients with cardiomyopathies.

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Impact of beta-blockers on sleep in patients with mild hypertension: a randomized trial between nebivolol and metoprolol

Abstract: Nebivolol was associated with improved sleep (as assessed by the PSQI), whereas metoprolol was associated with a worsening of sleep characteristics.

Cited by 31 publications

References 18 publications

Nebivolol: impact on cardiac and endothelial function and clinical utility

Nebivolol: impact on cardiac and endothelial function and clinical utility

Disturbed subjective sleep characteristics in adult patients with long-standing type 1 diabetes mellitus

Sleep Quality and Quality of Life in Patients with Hypertrophic Cardiomyopathy

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