title: Independent association of drug-resistant hypertension to reduced sleep duration and efficiency.
abstract: BACKGROUND
  Experimentally induced sleep deprivation can raise blood pressure (BP) and worsen hypertension. We recently reported a significantly higher prevalence of obstructive sleep apnea (OSA) and reduced rapid eye movement (REM) sleep time in drug-resistant hypertensives compared to controlled hypertensives. The objective of this study was to test the hypothesis that short sleep duration is associated with resistant hypertension (RH) independently of OSA, which can itself disrupt and shorten sleep.
  
  
  METHODS
  In a case-control study, overnight polysomnographic results of subjects with OSA and RH (n = 62) were compared to those with OSA of equal severity and either controlled hypertension (CH) (n = 49) or normotension (n = 40).
  
  
  RESULTS
  Subjects with RH slept 33.8 min (P = 0.02) and 37.2 min (P = 0.02) less than those with CH and normotension, respectively. Consequently, sleep efficiency was reduced by 7.9% (P = 0.007) and 10.2% (P = 0.002), respectively. They also spent 9.7 min (P = 0.06) and 11.6 min (P = 0.04) less time in REM sleep compared to those with CH and normotension, respectively. Older age, greater body mass index (BMI) and greater apnea-hypopnea index (AHI) were also associated with shorter sleep time (P = 0.02, P = 0.001, and P = 0.03, respectively) and reduced sleep efficiency (P = 0.0003, P = 0.03, and P = 0.01, respectively).
  
  
  CONCLUSIONS
  Our study demonstrates that, compared to subjects with CH or normotension, those with RH have shorter total and REM sleep times and lower sleep efficiency independently of OSA. These data suggest that reduced sleep time may contribute to the severity of hypertension.
authors.affiliation: Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute of the Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Oded
authors.initials: O
authors.lastname: Friedman
authors.forename: T Douglas
authors.initials: TD
authors.lastname: Bradley
authors.forename: Pimon
authors.initials: P
authors.lastname: Ruttanaumpawan
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D015992:Body Mass Index; D016022:Case-Control Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000150:complications; D012894:Sleep Stages / Q000187:drug effects / Q000502:physiology; D012893:Sleep Wake Disorders / Q000150:complications*