Ambulatory blood pressure and cardiovascular outcome in relation to perceived sleep deprivation.
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), <2 hours less than usual (group B), 2 to 4 hours less than usual (group C), and >4 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 <0.01). 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 >10% compared with those with a greater day-night BP drop in the group with perceived sleep duration as usual or <2 hours less than usual (both P<0.01), not in the group with duration of sleep >or=2 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 >or=2 hours. In conclusion, nighttime BP rises and loses its prognostic significance in the hypertensive subjects who perceive a sleep deprivation by >or=2 hours during overnight monitoring.
Verdecchia
Paolo
P
Struttura Complessa di Cardiologia, Unità di Ricerca Clinica-Cardiologia Preventiva, Ospedale S. Maria della Misericordia, Università di Perugia, Perugia, Italy. verdec@tin.it
Angeli
Fabio
F
Borgioni
Claudia
C
Gattobigio
Roberto
R
Reboldi
Gianpaolo
G
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002940:Circadian Rhythm; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012892:Sleep Deprivation / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors