title: Morning blood pressure is associated with sleep quality in obese adolescents.
abstract: OBJECTIVE
  To examine relationships among blood pressure (BP), adiposity, and sleep quality with the use of overnight polysomnography in obese adolescents.
  
  
  METHODS
  Overnight polysomnogram and morning BP measurements were performed in obese (body mass index [BMI] >95th percentile) nondiabetic adolescents (eligible age range 12-18 years, n = 49). Subjects were stratified into 2 groups, one with normal BP, and one with elevated BP, and demographic and clinical characteristics were compared between the groups. Multiple linear regression analysis was used to assess the effects of sleep quality on BP.
  
  
  RESULTS
  Participants (n = 27) had a normal morning BP, and 22 (44.9%) had elevated morning BP. There were no differences in age (P = .53), sex (P = .44), race (P = .58), or BMI (P = .56) between the 2 BP groups. The group with elevated BP spent shorter percentages of time in rapid eye movement (REM; P = .006) and slow-wave sleep (SWS; P = .024). Multiple linear regression analysis showed that a lower percentage of both REM and SWS was associated with increased morning BP after we adjusted for pubertal stage, sex, race, and BMI.
  
  
  CONCLUSIONS
  Lack of deeper stages of sleep, REM sleep, and SWS is associated with greater morning BP in obese adolescents, independent of BMI. Poor sleep quality should be considered in the work-up of obese youth with hypertension. Intervention studies are needed to evaluate whether improving the quality of sleep will decrease BP elevation.
authors.affiliation: Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, IN. Electronic address: tshannon@iu.edu.
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Hannon
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.affiliation: Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Watson
authors.affiliation: Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hasnaa
authors.initials: H
authors.lastname: Jalou
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Chakravorty
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Silva A
authors.initials: SA
authors.lastname: Arslanian
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*
keywords: AHI; Apnea-hypopnea index; BMI; BP; Blood pressure; Body mass index; DBP; Diastolic blood pressure; PSG; Polysomnogram; REM; Rapid eye movement; SBP; SWS; Saturation level of oxygen in hemoglobin; Slow-wave sleep; SpO(2); Systolic blood pressure