The Effect of Measuring Ambulatory Blood Pressure on Nighttime Sleep and Daytime Activity—Implications for Dipping

Abstract

Design, setting, participants, & measurements: To assess the effect of ambulatory BP monitoring on sleep duration, sleep efficiency, and daytime activity, we measured physical activity using wrist actigraphy in 103 veterans with chronic kidney disease. After 6 to 7 days of continuous activity monitoring, participants underwent ambulatory BP monitoring with simultaneous actigraphy. The above experiment was repeated after 1 mo.Results: Among the top tertile of patients (most sleep), when wearing ambulatory BP patients spent less time in bed at night (؊92 min, P < 0.0001), were less asleep during those hours (؊98 min, P < 0.0001), and had reduced sleep efficiency (82% versus 77%, ؊5% P ‫؍‬ 0.02). On the day of ambulatory BP monitoring, patients were more sedentary during waking hours (؉27 minutes, P ‫؍‬ 0.002). During ambulatory BP monitoring, waking after sleep onset more than median was associated with greater odds for nondipping (odds ratio 10.5, P ‫؍‬ 0.008).Conclusions: Ambulatory BP monitoring is associated with disturbed sleep and reduced physical activity, characteristics that influence dipping. Ambulatory BP monitoring may itself induce nondipping and may thus mitigate the prognostic significance of the dipping phenomenon.

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

“…54 Similarly, when 24 hour ABPM was performed serially in 4 month intervals in 34 CKD patients the dipping status changed in 38% of paired examinations. 58 This may be on account of a combination of the poor sleep experienced by CKD patients 53 coupled with the ABPM procedure itself as it is associated with reduced daytime activity and poorer sleep, 59 both of which would be expected to reduce dipping. To improve reproducibility, routine 48 hour ABPM has been suggested as an alternative to 24 hour ABPM, and while 48 hour ABPM has been shown to reduce variability, it has not yet been shown to improve reproducibility.…”

Hypertension in pediatric patients with chronic kidney disease: management challenges

“…95 Diagnosis and monitoring of HTN depends on accurate BP measurements; however, this is complicated in patients with CKD due to disease-induced alterations in diurnal BP rhythms. 5,96 There are three commonly used ways of monitoring BP: casual BP measurement, self-measured BP, and ABPM. Precise recordings in children are difficult with casual BP measurements, as it is often challenging for the child to sit still for the 5 minutes needed to obtain recordings.…”

“…It has been found that when wearing an ABPM, patients spent less time in bed at night, were more restless during those hours, and had reduced sleep efficiency in general. 96 During the day, patients were more sedentary while wearing the monitor. In CKD patients, it is common to have a loss of the typical nocturnal decline in BP by 10%-20%, as seen in healthy individuals.…”

“…In CKD patients, it is common to have a loss of the typical nocturnal decline in BP by 10%-20%, as seen in healthy individuals. 96 This loss is common in patients with CKD, and is associated with LVH and adverse cardiovascular events. 47,96 Increased BP variability is related to worse outcome, particularly in patients on dialysis who are subject to marked BP swings.…”

Thirty-minute compared to standardised office blood pressure measurement in general practice

“…ABPM is not very patient friendly, 5 and is associated with disturbed sleep. 6 Home blood pressure measurements may be inaccurate because of poor measurement technique 7 and report bias. 8 These aspects make ABPM techniques less suitable for routine use in daily practice.…”