title: Sleep quality and blood pressure dipping in normal adults.
abstract: OBJECTIVE
  To investigate the relationship between sleep quality and nocturnal blood pressure dipping in normal subjects. We hypothesized that sleep quality correlates with dipping.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Unattended polysomnography in the home followed by a 24-hour ambulatory blood pressure measurement.
  
  
  METHODS
  Eighty-eight self-described normal subjects were evaluated; 26 were excluded due to an apnea-hypopnea index > or = 10. None were taking antihypertensive medications.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  Subjects were divided into dippers and nondippers based on > or = 10% drop in nocturnal mean arterial pressure (MAP). Sleep-quality variables included total sleep time; sleep latency; percentage of stages 1, 2, 3, 4, and rapid-eye-movement sleep; percentage of wake time after sleep onset (WASO); total arousal index; and sleep efficiency. Of the remaining 62 subjects, 17.7% were nondippers, and 7 were hypertensive. There was no difference in age, body mass index, apnea-hypopnea index, blood pressure, or sleep quality between groups. Stage 4 sleep correlated significantly with dipping of diastolic blood pressure and MAP (r = 0.410 and 0.378, respectively, P < or = .002), and percentage of WASO was negatively correlated with dipping of diastolic blood pressure (r = -0.360, P = .004), suggesting that greater dipping was associated with better sleep quality. On multivariate analyses, Stage 4 sleep was independently associated with dipping of diastolic blood pressure (P = .034) after adjusting for screening MAP, percentage of WASO, total arousal index, and Stage 1 sleep. The same link was found between Stage 4 sleep and dipping of MAP (P = .05) after adjusting for screening MAP, age, sex, and body mass index. Repeat analyses excluding hypertensives yielded similar findings.
  
  
  CONCLUSIONS
  Our data suggest that deeper and less-fragmented sleep is associated with more blood pressure dipping in normal subjects.
authors.affiliation: Department of Medicine, University of California, San Diego, 92103-0804, USA. jloredo@ucsd.edu
authors.forename: José S
authors.initials: JS
authors.lastname: Loredo
authors.forename: Richard
authors.initials: R
authors.lastname: Nelesen
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003700:Delta Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology