title: Sleep Duration, Kidney Function, and Their Effects on Cerebral Small Vessel Disease in Elderly Hypertensive Patients.
abstract: BACKGROUND
  Short sleep duration has been shown to be associated with cardio/cerebrovascular disease. White matter hyperintensities (WMH) have been associated with an increased risk of stroke. In addition to high ambulatory blood pressure (BP), chronic kidney disease (CKD) is a risk for WMH. In this study, we investigated the relationships among sleep duration, CKD, and WMH in elderly hypertensives.
  
  
  METHODS
  Ambulatory BP monitoring and brain magnetic resonance imaging were performed in 514 Japanese elderly hypertensives (mean age 72.3 years, males 37%). WMH cases were further divided into deep subcortical white matter lesion or periventricular hyperintensity (PVH). CKD (n = 193) was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m(2).
  
  
  RESULTS
  According to sleep duration (<7.5, ≥7.5 to <9.5, and ≥9.5 hour per night), significant associations of sleep duration were observed with WMH and PVH. In the regression analysis including age, gender, smoking, antiplatelet agents use, 24-hour systolic BP, nondipper, white coat hypertension and CKD, short sleep duration was significantly positively associated with WMH and PVH when subjects with mid-range sleep duration were used as a reference group. A significant interaction was found between short sleep duration and CKD for PVH. In the non-CKD group, short sleep duration had strong significant positive associations with WMH and PVH.
  
  
  CONCLUSIONS
  In the present study, short sleep duration was a positive significant determinant for WMH and PVH in elderly hypertensives. Sleep duration might serve as a strong determinant for white matter lesions especially in those without CKD.
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.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Shimpo
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. kkario@jichi.ac.jp.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D056784:Leukoencephalopathies / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D012890:Sleep; D013997:Time Factors
keywords: blood pressure; cerebral small vessel disease; hypertension; kidney function; sleep duration; white matter hyperintensity.