title: Nocturnal pulse wave attenuation is associated with office blood pressure in a population based cohort.
abstract: OBJECTIVE
  Pulse wave amplitude (PWA) derived from the digital vascular bed has been used in sleep studies. The nocturnal attenuation of PWA has been shown to reflect sympathetic activation during sleep. We assessed the relationship between nocturnal PWA attenuation and office blood pressure (BP).
  
  
  METHODS
  Eighty-one subjects (46 men; age 60+/-7 years; body mass index [BMI] 28.2+/-4.3 kg/m(2); apnea hypopnea index [AHI], 25.4+/-22.6 events/h; systolic BP 137+/-15 mm Hg; diastolic BP 79+/-7 mm Hg) recruited from a population based cohort underwent simultaneous ambulatory polysomnography (PSG) and peripheral arterial tonometry (PAT) recording. Episodic attenuations of PWA derived from the pulse waveform of the PAT signal were identified and characterized. Generalized least squares regression models were used to identify the associations between median PWA attenuation (PWA.att), office BP and sleep-related disordered breathing.
  
  
  RESULTS
  We found that the association between PWA.att and office BP was independent of gender, age, BMI, antihypertensive medication, number of attenuation episodes, AHI, oxygen desaturation 4% index (ODI4) and arousal index. Each 10% increase in PWA.att was associated with increases of 5.0 mm Hg systolic BP (P=0.02) and 3.0 mm Hg diastolic BP (P=0.005). We also found independent relationships between systolic/diastolic BP and BMI (P=0.0006/0.001), AHI (P=0.03/0.1) and ODI4 (P=0.03/0.03).
  
  
  CONCLUSIONS
  The degree of PWA attenuation during the night is associated with office BP independent of sleep-disordered breathing. Continuous assessment of PWA during sleep may provide novel insights into cardiovascular physiology and morbidity.
authors.affiliation: Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. zou.ding@lungall.gu.se
authors.forename: Ding
authors.initials: D
authors.lastname: Zou
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
authors.forename: Jakub
authors.initials: J
authors.lastname: Radlinski
authors.forename: Derek N
authors.initials: DN
authors.lastname: Eder
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010824:Physicians' Offices; D017286:Polysomnography; D011673:Pulsatile Flow / Q000502:physiology*; D012044:Regression Analysis; D012891:Sleep Apnea Syndromes / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000502:physiology*