Association of Sleep Characteristics With Nocturnal Hypertension and Nondipping Blood Pressure in the CARDIA Study

Abstract

Background Sleep characteristics and disorders are associated with higher blood pressure ( BP ) when measured in the clinic setting. Methods and Results We tested whether self‐reported sleep characteristics and likelihood of obstructive sleep apnea ( OSA ) were associated with nocturnal hypertension and nondipping systolic BP ( SBP ) among participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who completed 24‐hour ambulatory BP monitoring during the year 30 examination. Likelihood of OSA was determined using the STOP ‐Bang questionnaire. Global sleep quality, habitual sleep duration, sleep efficiency, and midsleep time were obtained from the Pittsburgh Sleep Quality Index. Nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or diastolic BP ≥70 mm Hg. Nondipping SBP was defined as a decline in awake‐to‐asleep SBP <10%. Among 702 participants, the prevalence of nocturnal hypertension and nondipping SBP was 41.3% and 32.5%, respectively. After multivariable adjustment including cardiovascular risk factors, the prevalence ratios (PRs) for nocturnal hypertension and nondipping SBP associated with high versus low likelihood of OSA were 1.32 (95% CI, 1.00–1.75) and 1.31 (95% CI, 1.02–1.68), respectively. The association between likelihood of OSA and nocturnal hypertension was stronger for white participants (PR: 2.09; 95% CI, 1.23–3.48) compared with black participants (PR: 1.11; 95% CI, 0.79–1.56). The PR for nondipping SBP associated with a 1‐hour later midsleep time was 0.92 (95% CI, 0.85–0.99). Global sleep quality, habitual sleep duration, and sleep efficiency were not associated with either nocturnal hypertension or nondipping SBP . Conclusions These findings suggest that addressing OSA risk and sleep timing in a clinical trial may improve BP during sleep.

Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy

“…Hypertension is present in up to 50% of patients with OSA, which is about double the prevalence of hypertension in general population studies [ 2 ]. A non-dipping nocturnal blood pressure (BP) profile (<10% day-to-night systolic blood pressure difference) is especially likely in OSA patients [ 3 – 6 ], even in the absence of significant hypertension. The likelihood of non-dipping BP correlates with OSA severity in population studies [ 7 ], and cardiovascular events are more frequent in OSA patients with a non-dipping BP profile than those with a normal dipping pattern, even in the absence of diagnosed hypertension [ 8 ].…”

Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge

“…[ 17 , 18 ] The mechanisms involved in the morning increase in cardiovascular events have been unclear, but recent clinical studies have shown that an exaggerated morning BP surge is a plausible factor involved in the triggering of cardiovascular events, particularly in the case of stroke. [ 18 , 19 ] 1 mm Hg morning BP increase was associated with a 2.1% increased risk of cardiovascular death. [ 3 , 4 ] More and more evidences [ 20 – 22 ] show that the morning surge of blood pressure is closely related to cardiovascular events, stroke, and renal impairment.…”

Short sleep duration and physical and psychological health outcomes among adult survivors of childhood cancer

“…For instance, blood pressure often decreases at night (i.e., nocturnal dipping) and lack of decrease (i.e., non-dipping), which is associated with increased risk of cardiovascular disease, 38 is more prevalent among individuals with sleep disturbances, such as obstructive sleep apnea and advanced sleep cycles. 39 The potential causal significance of poor sleep and its associations with adverse health outcomes are reinforced by several prospective studies 17,15,16 /reviews. 14,30 However, though there are several biological pathways through which sleep patterns and sleep disturbances could affect chronic health conditions, these relationships and their directions have not been fully elucidated.…”

“…Other physiological processes follow diurnal patterns and may be disrupted by sleep disturbances. For instance, blood pressure often decreases at night (i.e., nocturnal dipping) and lack of decrease (i.e., non‐dipping), which is associated with increased risk of cardiovascular disease, 38 is more prevalent among individuals with sleep disturbances, such as obstructive sleep apnea and advanced sleep cycles 39 …”