Blood Pressure “Dipping” and “Non-Dipping” in Obstructive Sleep Apnea Syndrome Patients

Suzuki, Mayumi; Guilleminault, Christian; Otsuka, Kuniaki; Shiomi, Toshiaki

doi:10.1093/sleep/19.5.382

Cited by 186 publications

(102 citation statements)

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“…41 Similarly, wakefulness and sleep impact BP pattern, as sleep deprivation is associated with increased sympathetic activity 42;43 and nondipping has been positively correlated to the apnea-hypopnea index used to grade sleep disordered breathing. 44 Sodium Sensitivity-Nondipping has been associated with sodium sensitivity in hypertensive patients, 45 and both sodium restriction 45;46 and thiazide diuretics 47 have been shown to restore dipping in these salt sensitive patients. Potential mechanistic links between salt sensitivity and nondipping include impaired baroreflex function leading to sympathetic activation 48 and impaired endothelial function, which is both common in nondippers 49 and which has been shown to be associated with salt sensitivity in an animal model.…”

Section: Physiology Of Dippingmentioning

confidence: 99%

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Sinha

Agarwal

2015

Advances in Chronic Kidney Disease

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Hypertension and chronic kidney disease (CKD) frequently coexist, and both are risk factors for cardiovascular events and mortality. Among people with hypertension, the loss of the normal fall in nighttime BP, called nondipping, can only be diagnosed by ambulatory BP monitoring (ABPM), and is a risk factor for cardiovascular events. The pathophysiology of nondipping is complex, and CKD is an independent risk factor for non-dipping. In fact, non-dipping can be seen in as many as 80% of people with CKD. However, the evidence for nondipping as an independent risk factor or causal agent for adverse outcomes in CKD remains mixed. ABPM has been shown to be superior to clinic BP measurement for correlating with end organ damage and prognosis in CKD. This review covers the evidence for the use of ABPM in CKD, the evidence linking ABPM patterns to outcome in CKD, and the evidence for treatment of nondipping in CKD.

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Section: Physiology Of Dippingmentioning

confidence: 99%

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Sinha

Agarwal

2015

Advances in Chronic Kidney Disease

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“…Regardless of the method used, essentially all studies have reported that OSA is associated with increased sympathetic activity. 20,22,24,25 Furthermore, unlike the situation in normal subjects, blood pressure 26 and sympathetic activity remain high during sleep in OSA patients. These findings highlight the challenges of using autonomic signals to detect sleep stages in OSA patients.…”

Section: Light/deep Sleep Detectionmentioning

confidence: 99%

Sleep Staging Based on Autonomic Signals: A Multi-Center Validation Study

Hedner

White

Malhotra

et al. 2011

Journal of Clinical Sleep Medicine

123

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Study Objectives: One of the most important caveats of ambulatory devices is the inability to record and stage sleep. We assessed an algorithm determining 4 different stages: wake, light sleep, deep sleep, and REM sleep using signals derived from the portable monitor Watch-PAT100 (PAT recorder). Methods: Participants (38 normal subjects and 189 patients with obstructive sleep apnea [OSA]) underwent simultaneous overnight recordings with polysomnography (PSG) and the PAT recorder in a study originally designed to assess the accuracy of the PAT recorder in diagnosing OSA. Light/deep sleep and REM sleep from the PAT recorder recording were automatically scored based on features extracted from time series of peripheral arterial tone amplitudes and inter pulse periods. The PSG scored sleep stages 1 and 2 were classified as light sleep for epoch-by-epoch comparisons. Results:The overall agreement in detecting light/deep and REM sleep were 88.6% ± 5.9% and 88.7% ± 5.5%, respectively. There was a good agreement between PSG and the PAT recorder in quantifying sleep efficiency (78.4% ± 9.9% vs. 78.8% ± 13.4%), REM latency (237 ± 148 vs. 225 ± 159 epochs), and REM percentage (14.4% ± 6.5% vs. 19.3% ± 8.7%). OSA severity did not affect the sensitivity and specificity of the algorithm. The Cohen κ coefficient for detecting all sleep stages: sleep from wake, REM from NREM sleep, and deep from light sleep were 0.48, 0.55, 0.59, and 0.46, respectively. Conclusions: Analysis of autonomic signals from the PAT recorder can detect sleep stages with moderate agreement to more standard techniques in normal subjects and OSA patients. This novel algorithm may provide insights on sleep and sleep architecture when applying the PAT recorder for OSA diagnosis.

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“…4,5 It is known that patients with sleep apnea are more likely to have a nondipping blood pressure profile than hypertensive patients without sleep apnea. 6 However, not all patients with sleep apnea syndrome have a nondipping blood pressure profile and hence this may only be one of many contributing factors to the nondipping blood pressure profile.…”

Section: Introductionmentioning

confidence: 99%

Sleep actigraphy in hypertensive patients with the ‘non-dipper’ blood pressure profile

Mansoor

2002

J Hum Hypertens

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Several prospective studies have demonstrated a higher cardiovascular complication rate in patients with a nondipping compared with a dipping blood pressure profile. However, the extent of blood pressure reduction during sleep can be highly variable in an individual patient, and a repeat ambulatory blood pressure study commonly shows a change in category. The reasons for this variability are not clear. In general, hypertensive patients with a non-dipper blood pressure profile have higher actigraphy-measured activity during time in bed than dipper hypertensive patients but no analysis of actigraphy-determined sleep parameters has been published. We therefore prospectively studied 52 hypertensive patients who were off antihypertensive drugs for at least 3 weeks and who underwent simultaneous ambulatory and wrist actigraphy monitoring. All patients were clinically free of any sleep-related disorder. The blood pressure profile was labelled dipper when the change in mean awake blood pressure to sleep blood pressure was 10% or higher and non-dipper if less than 10%.

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Blood Pressure “Dipping” and “Non-Dipping” in Obstructive Sleep Apnea Syndrome Patients

Cited by 186 publications

References 0 publications

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Sleep Staging Based on Autonomic Signals: A Multi-Center Validation Study

Sleep actigraphy in hypertensive patients with the ‘non-dipper’ blood pressure profile

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