Sleep Structure in Essential Hypertensive Patients: Differences between Dippers and Non-Dippers

Pedullà, M.; Silvestri, Rosalia; Lasco, Antonino; Mento, G.; Lanuzza, Bartolo; Sofia, Lorenzo; Frisina, N

doi:10.3109/08037059509077600

Cited by 58 publications

(40 citation statements)

References 14 publications

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“…This finding is in contrast to those reported in other studies in which poorer sleep quality was associated with nondipping BP, as determined by actigraphic (30) and polysomnographic data (47). Additionally, individuals with a nondipping BP pattern have also been found to report poorer sleep quality on subjective measures of perceived sleep (48).…”

Section: Discussioncontrasting

confidence: 56%

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Routledge

McFetridge-Durdle

Dean

2009

Canadian Journal of Cardiology

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C ardiovascular disease is a leading cause of death of men and women in Canada (1). Cardiovascular disease-related deaths account for 34% of all deaths among Canadian women and 32% of all deaths among Canadian men (1).Hypertension is strongly and independently related to cardiovascular morbidity and mortality (2). In Canada, hypertension is more common in women older than 55 years of age than in age-matched men (3). According to the Heart and Stroke Foundation of Canada (3), more than one-third of postmenopausal Canadian women have hypertension. Although the explanation for hypertension in menopause is not fully understood, estrogen depletion, general aging and/or body weight are believed to contribute to the blood pressure (BP) changes (4).Ambulatory BP monitoring (ABPM) is a noninvasive technology used for the evaluation of individuals with suspected and established hypertension (5). ABPM has revealed a diurnal variation in BP. The normal variation in BP is characterized by a 10% or greater reduction in BP from day to night (6). Individuals with this nighttime dip in BP are known as dippers and those who do not dip are known as nondippers. Nondippers have a less than 10% reduction in BP during sleep (7).Although controversial, evidence suggests that individuals with a nondipping BP profile are at risk for greater cardiovascular morbidity and poorer outcomes (8-15). Some researchers have also reported greater target organ damage among hypertensive nondipping women than among hypertensive nondipping men (16). It has been estimated that 25% of essential hypertensive patients have a nondipping BP pattern (17).The exact mechanisms of action responsible for nondipping BP are not fully understood. It is believed that the autonomic nervous system -in particular, the sympathetic nervous system -has an effect on circadian BP variation. Researchers have demonstrated that during the night, nondippers have increased sympathetic nervous system clinical StudieS ©2009 Pulsus Group Inc. All rights reserved BACKGROUND: A less than 10% decline in blood pressure during the night is known as a nondipping blood pressure (BP) pattern. Nondipping BP has been shown to be associated with target organ damage and poorer cardiovascular outcomes. Additionally, some evidence suggests that hypertensive nondipping women are at greater risk for target organ damage than hypertensive nondipping men. OBJECTIVE: To determine whether stress, demographics, menopausal status or sleep quality are associated with nondipping BP among hypertensive women. METHODS: A cross-sectional study design was used to describe the relationship between stress and dipping status among a sample of hypertensive women and to describe the sample by age, ethnicity, marital status, menopausal status, current medications and sleep quality. RESULTS:The study sample consisted of 47 women (mean [± SD] age 57±13.9 years) with essential or office hypertension who underwent 24 h ambulatory BP monitoring, and completed stress and sleep quality measurements. Thirty-one women (66%) we...

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Section: Discussioncontrasting

confidence: 56%

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Routledge

McFetridge-Durdle

Dean

2009

Canadian Journal of Cardiology

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“…The circadian rhythm of BP is blunted in patients with insomnia, even in those who are normotensive (Lanfranchi et al, 2009). Inversely, non‐dippers have poor quality of sleep (Pedulla et al, 1995). …”

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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“…7 Studies carried out in sleep laboratories produced conflicting results in showing no changes 8 and an increase 9,10 in the number of nocturnal awakenings during overnight monitoring. The picture is complicated by the finding that hypertensive subjects with a blunted day-night fall in BP ("non-dippers") 11 present more frequent microarousals 12 and apneic snoring 13 as compared with subjects with normal day-night BP fall, but evidence is controversial. 14 Overall, available studies suggest that nighttime BP could be altered by the sleep noise induced by repeated cuff inflations but do not clarify the prevalence of this phenomenon or, more importantly, its prognostic significance.…”

mentioning

confidence: 87%

“…In a study, the number of microarousals, but not of arousals, was higher in nondippers than in dippers. 12 Another study found a significantly higher number of episodes of sleep apnea and snoring in nondippers than in dippers. 13 …”

Section: Interference On Sleep Quality and Nighttime Bpmentioning

confidence: 99%

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

Verdecchia¹,

Borgioni²,

Gattobigio³

et al. 2007

Hypertension

116

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Abstract-Sleep deprivation induced by cuff inflations during overnight blood pressure (BP) monitoring might interfere with the prognostic significance of nighttime BP. In 2934 initially untreated hypertensive subjects, we assessed the perceived quantity of sleep during overnight BP monitoring. Overall, 58.7%, 27.7%, 9.7%, and 4.0% of subjects reported a sleep duration perceived as usual (group A), Ͻ2 hours less than usual (group B), 2 to 4 hours less than usual (group C), and Ͼ4 hours less than usual (group D). Daytime BP did not differ across the groups (all Ps not significant). Nighttime BP increased from group A to D (124/75, 126/76, 128/77, and 129/79 mm Hg, respectively; all Ps for trend Ͻ0.01). Over a median follow-up period of 7 years there were 356 major cardiovascular events and 176 all-cause deaths. Incidence of total cardiovascular events and deaths was higher in the subjects with a night/day ratio in systolic BP Ͼ10% compared with those with a greater day-night BP drop in the group with perceived sleep duration as usual or Ͻ2 hours less than usual (both PϽ0.01), not in the group with duration of sleep Ն2 hours less than usual (all Ps not significant). In a Cox model, the independent prognostic value of nighttime BP for total cardiovascular end points and all-cause mortality disappeared in the subjects with perceived sleep deprivation Ն2 hours. In conclusion, nighttime BP rises and loses its prognostic significance in the hypertensive subjects who perceive a sleep deprivation by Ն2 hours during overnight monitoring. Key Words: hypertension Ⅲ dippers Ⅲ nondippers Ⅲ blood pressure monitoring Ⅲ sleep Ⅲ stroke Ⅲ myocardial infarction Ⅲ epidemiology D espite the growing body of evidence supporting the prognostic value of nighttime blood pressure (BP), 1-6 it is unclear to what extent the compressive, tactile, and sonorous stimuli produced by repeated cuff inflations during 24-hour ambulatory BP (ABP) monitoring interfere with nighttime BP measurements, possibly through sleep disturbance or deprivation. In a study, intra-arterial ABP did not differ during day and night in the presence versus absence of concomitant noninvasive ABP monitoring. 7 Studies carried out in sleep laboratories produced conflicting results in showing no changes 8 and an increase 9,10 in the number of nocturnal awakenings during overnight monitoring. The picture is complicated by the finding that hypertensive subjects with a blunted day-night fall in BP ("non-dippers") 11 present more frequent microarousals 12 and apneic snoring 13 as compared with subjects with normal day-night BP fall, but evidence is controversial. 14 Overall, available studies suggest that nighttime BP could be altered by the sleep noise induced by repeated cuff inflations but do not clarify the prevalence of this phenomenon or, more importantly, its prognostic significance. The clinical impact of this issue is relevant because of the growing reliance on nighttime BP when interpreting results of ABP monitoring. Thus, the aim of the present study was to determine t...

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Sleep Structure in Essential Hypertensive Patients: Differences between Dippers and Non-Dippers

Cited by 58 publications

References 14 publications

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

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

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

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