title: Sleep duration and insomnia in the elderly: associations with blood pressure variability and carotid artery remodeling.
abstract: BACKGROUND
  Recent studies have shown that short and long sleep durations and insomnia are associated with increased home-measured blood pressure (BP) variability, which in turn has a relationship with arterial stiffness. However, the determinants for visit-to-visit systolic blood pressure (SBP) variability have rarely been investigated in relation to sleep duration, insomnia, and carotid arterial stiffness.
  
  
  METHODS
  The subjects were 201 elderly individuals (79.9±6.4 years old) with one or more cardiovascular risks. Based on 12 visits, visit-to-visit BP variability (expressed as a coefficient of variation [CV]) and δ (maximum - minimum) BP were measured. Self-reported sleep duration and insomnia questionnaires were used to classify the patients according to sleep duration period and insomnia status.
  
  
  RESULTS
  After multivariable adjustment, long sleep duration (≥ 9 hours per night) had significant positive associations with SBP δ (P < 0.05), while persistent insomnia had significant positive associations with SBP CV (P < 0.05) and δ (P < 0.01). Additionally, significant interactions were found in terms of long sleep duration by carotid artery stiffness parameter β (P < 0.05), persistent insomnia by intima-media thickness (P < 0.01), and persistent insomnia by stiffness parameter β (P < 0.05) for SBP δ.
  
  
  CONCLUSIONS
  In elderly patients at high risk for cardiovascular disease, long sleep duration as well as persistent insomnia were significantly associated with higher visit-to-visit BP variability. Long sleep duration and persistent insomnia each had synergetic interactions with carotid artery stiffness and with visit-to-visit BP variability.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Nagai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Mami
authors.initials: M
authors.lastname: Nishikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000503:physiopathology*; D012907:Smoking / Q000503:physiopathology; D013997:Time Factors; D059289:Vascular Stiffness / Q000502:physiology*
keywords: arterial stiffness; blood pressure; hypertension; insomnia; sleep duration; visit-to-visit BP variability.