Subjective sleep disturbance increases the nocturnal blood pressure level and attenuates the correlation with target-organ damage.
OBJECTIVE
We aimed to investigate whether subjective sleep disturbance during overnight blood pressure (BP) monitoring results in higher night-time BP levels, and whether this affects the correlation between nocturnal BP and hypertensive target-organ damage.


METHODS
In 203 untreated hypertensive patients (104 men) without a history of cardiovascular disease, with a mean age of 52.1 ± 12.5 years, and with office BP levels of 170 ± 23/104 ± 12 mmHg, we performed duplicate ambulatory BP monitoring (ABPM), assessed subjective sleep quality using the Groningen Sleep Quality Scale, and obtained information on hypertension-related cardiac damage by echocardiography.


RESULTS
Overnight BP monitoring disturbed sleep significantly, but habituation to nocturnal measurements occurred on the second ABPM. Participants whose subjective sleep quality was less than usual on either ABPM did not have higher nocturnal BP levels than those who slept similar to usual (P > 0.05). When comparing the nocturnal BP levels between the first and second ABPM, we found that participants whose subjective sleep quality was less on the second ABPM had significantly higher pressure levels and a smaller BP dip than participants with a similar sleep quality for both ABPMs (P < 0.05). Accordingly, the correlations between the nocturnal BP and cardiac damage tended to be weaker based on the ABPM with the lowest sleep quality.


CONCLUSIONS
Subjectively assessed sleep disturbance during overnight BP monitoring increases the nocturnal BP level and potentially attenuates the correlation with hypertension-related cardiac damage, even though habituation to overnight BP monitoring occurs.
Department of Internal Medicine, Division of General Internal Medicine, Subdivision Vascular Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands.
Léon H G
LH
Henskens
Martin P J
MP
van Boxtel
Abraham A
AA
Kroon
Robert J
RJ
van Oostenbrugge
Jan
J
Lodder
Peter W
PW
de Leeuw
D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000009:adverse effects*; D002940:Circadian Rhythm / Q000502:physiology; D020920:Dyssomnias / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006185:Habituation, Psychophysiologic; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012890:Sleep