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BaHammam AS, Alshahrani M, Aleissi SA, Olaish AH, Alhassoon MH, Shukr A. Blood pressure dipping during REM and non-REM sleep in patients with moderate to severe obstructive sleep apnea. Sci Rep 2021; 11:7990. [PMID: 33846490 PMCID: PMC8041780 DOI: 10.1038/s41598-021-87200-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
A limited number of papers have addressed the association between non-dipping-blood pressure (BP) obstructive sleep apnea (OSA), and no study has assessed BP-dipping during rapid eye movement (REM) and non-REM sleep in OSA patients. This study sought to noninvasively assess BP-dipping during REM and non-REM (NREM)-sleep using a beat-by-beat measurement method (pulse-transit-time (PTT)). Thirty consecutive OSA patients (men = 50%) who had not been treated for OSA before and who had > 20-min of REM-sleep were included. During sleep, BP was indirectly determined via PTT. Patients were divided into dippers and non-dippers based on the average systolic-BP during REM and NREM-sleep. The studied group had a a median age of 50 (42–58.5) years and a body mass index of 33.8 (27.6–37.5) kg/m2. The median AHI of the study group was 32.6 (20.1–58.1) events/h (range: 7–124), and 89% of them had moderate-to-severe OSA. The prevalence of non-dippers during REM-sleep was 93.3%, and during NREM-sleep was 80%. During NREM sleep, non-dippers had a higher waist circumference and waist-hip-ratio, higher severity of OSA, longer-time spent with oxygen saturation < 90%, and a higher mean duration of apnea during REM and NREM-sleep. Severe OSA (AHI ≥ 30) was defined as an independent predictor of non-dipping BP during NREM sleep (OR = 19.5, CI: [1.299–292.75], p-value = 0.03). This short report demonstrated that BP-dipping occurs during REM and NREM-sleep in patients with moderate-to-severe OSA. There was a trend of more severe OSA among the non-dippers during NREM-sleep, and severe OSA was independently correlated with BP non-dipping during NREM sleep.
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Affiliation(s)
- Ahmed S BaHammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in The Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
| | - Mana Alshahrani
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salih A Aleissi
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed H Alhassoon
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Shukr
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Patzak A. Measuring blood pressure by a cuffless device using the pulse transit time. Int J Cardiol Hypertens 2021; 8:100072. [PMID: 33884365 PMCID: PMC7803028 DOI: 10.1016/j.ijchy.2020.100072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andreas Patzak
- Institute of Vegetative Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Moharram MA, Wilson LC, Williams MJA, Coffey S. Beat-to-beat blood pressure measurement using a cuffless device does not accurately reflect invasive blood pressure. Int J Cardiol Hypertens 2020; 5:100030. [PMID: 33447759 PMCID: PMC7803068 DOI: 10.1016/j.ijchy.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The availability of an accurate continuous cuffless blood pressure (BP) monitor would provide an alternative to both invasive continuous BP and 24-h intermittent cuff-based BP monitors. We investigated the accuracy of a cuffless beat to beat (BtB) device compared to both invasive BP (iBP) and brachial cuff BP (cBP) measurements. METHODS Patients undergoing clinically indicated coronary angiography (CA) and/or percutaneous coronary intervention (PCI) were recruited. After calibration to an initial cBP reading, BP was measured simultaneously using a BtB device (SOMNOtouch NIBP), brachial artery iBP, and cBP at two time points. RESULTS The study was terminated early due to a significant bias. Recordings from 14 participants (11 males, mean age 68.4 years) were analysed. Readings from BtB BP were higher than iBP. The bias between BtB BP and iBP was 34.3 mmHg (95%CI: 27.0, 41.5) and 23.6 mmHg (95%CI: 16.8, 30.4) for SBP and DBP respectively. A similar bias was seen between BtB BP and cBP, but cBP and iBP were largely in agreement. CONCLUSIONS In patients undergoing CA/PCI, significant differences were detected between BtB BP and both invasively measured and cuff BP. The non-invasive BtB BP measurement device tested is not suitable for clinical or research use.
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Affiliation(s)
- Mohammed A Moharram
- Department of Medicine - HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Luke C Wilson
- Department of Medicine - HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael JA Williams
- Department of Medicine - HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine - HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Picard F, Panagiotidou P, Weinig L, Steffen M, Tammen AB, Klein RM. Effect of CPAP therapy on nocturnal blood pressure fluctuations, nocturnal blood pressure, and arterial stiffness in patients with coexisting cardiovascular diseases and obstructive sleep apnea. Sleep Breath 2020; 25:151-161. [DOI: 10.1007/s11325-020-02075-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022]
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Laharnar N, Fatek J, Zemann M, Glos M, Lederer K, Suvorov AV, Demin AV, Penzel T, Fietze I. A sleep intervention study comparing effects of sleep restriction and fragmentation on sleep and vigilance and the need for recovery. Physiol Behav 2020; 215:112794. [PMID: 31874181 DOI: 10.1016/j.physbeh.2019.112794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Sleep deprivation is present not only in sleep disorders but also in numerous high demanding jobs and negatively affects cognition, performance and health. We developed a study design to distinguish the effects and need for recovery of two short-term disturbances - intermittent sleep fragmentation and partial sleep restriction. METHODS The randomized within-subjects design contained two weeks each with a baseline night, an intervention night of either sleep deprivation (5 h) or sleep fragmentation (light on every hour) and two undisturbed recovery nights. Twenty healthy male participants (mean age: 39.9 ± 7.4 years, mean BMI: 25.5 ± 2.2 kg/m²) underwent polysomnography, a psychomotor vigilance task (PVT), and subjective questions on well-being and sleep efficiency. RESULTS Percentage-wise, the restriction night had significant less wake times, less light sleep (stage 1), less REM sleep, but more deep sleep (stage 3) than the fragmentation night. The restriction week displayed a significant recovery effect regarding these sleep stages. The sleep fragmentation week presented a significant recovery effect regarding sleep onset times. PVT performance showed only a slight recovery effect after sleep restriction. Subjective sleep quality was reduced after both interventions with a significant recovery effect during restriction week only. CONCLUSIONS Short-term sleep restriction presented as a stronger sleep disturbance than short-term intermittent sleep fragmentation, including a stronger need for recovery. Already a one night sleep deprivation had an effect beyond two recovery days. The PVT was not sensitive enough to reveal significant changes. Next, autonomic parameters as possible biomarkers will be investigated.
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Affiliation(s)
- Naima Laharnar
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany.
| | - Joanna Fatek
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany
| | - Maria Zemann
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany
| | - Martin Glos
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany
| | | | - Alexander V Suvorov
- Russian Federation State Research Center, Institute of Biomedical Problems, Russian Academy of Science, Moscow, Russia
| | - Artem V Demin
- Russian Federation State Research Center, Institute of Biomedical Problems, Russian Academy of Science, Moscow, Russia
| | - Thomas Penzel
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany
| | - Ingo Fietze
- Charité - Universitaetsmedizin Berlin, Interdisciplinary Center of Sleep Medicine, Campus Charité Mitte, Luisenstr. 13, 10117 Berlin, Germany
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Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time. Sci Rep 2020; 10:3342. [PMID: 32094479 PMCID: PMC7039871 DOI: 10.1038/s41598-020-60281-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 02/01/2023] Open
Abstract
Rapid eye movement-predominant obstructive sleep apnea has been shown to be independently associated with hypertension. This study aimed to non-invasively measure blood pressure during the rapid eye movement (REM) and non-rapid eye movement (NREM) obstructive events and the post-obstructive event period. Thirty-two consecutive continuous positive airway pressure-naïve obstructive sleep apnea patients (men, 50%) aged 50.2 ± 12 years underwent overnight polysomnography. Blood pressure was assessed indirectly using a validated method based on the pulse transit time and pulse wave velocity during the NREM and REM obstructive events (both apneas and hypopneas) and the post-obstructive event period. Among the recruited patients, 10 (31.3%) had hypertension. Mean apnea-hypopnea index was 40.1 ± 27.6 events/hr. Apnea-hypopnea indexes were 38.3 ± 30.6 and 51.9 ± 28.3 events/hr for NREM and REM sleep, respectively. No differences were detected in obstructive respiratory event duration or degree of desaturation between REM and NREM sleep. Additionally, no difference in blood pressure (systolic and diastolic) was detected between REM and NREM sleep during obstructive events and post-obstructive event period. Simple linear regression identified history of hypertension as a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in both rapid eye movement and non-rapid eye movement sleep. Oxygen desaturation index was also a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in REM sleep. When obstructive event duration and the degree of desaturation were comparable, no difference in blood pressure was found between REM and NREM sleep during obstructive events and post-obstructive event period.
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Individual shear rate therapy (ISRT)-further development of external counterpulsation for decreasing blood pressure in patients with symptomatic coronary artery disease (CAD). Hypertens Res 2019; 43:186-196. [PMID: 31866668 DOI: 10.1038/s41440-019-0380-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 11/08/2022]
Abstract
Individual shear rate therapy (ISRT) evolved from external counterpulsation with individual treatment pressures based on Doppler ultrasound measurements. In this study, we assessed the effect of ISRT on blood pressure (BP) in patients with coronary artery disease (CAD). Eighty-four patients with symptomatic CAD were included in the study. Forty-one patients were enrolled for 6 weeks, comprising 30 sessions of ISRT; 43 age- and sex-matched patients represented the control group. The 24-h BP was determined by measuring the pulse transit time before and after 6 weeks of ISRT or the time-matched control. Participants were divided into three groups according to the 24-h BP before treatment: BP1 < 130/80 mmHg (normotensive); BP2 ≥ 130-140/80 mmHg (moderate hypertensive); BP3 > 140/80 mmHg (hypertensive). After 30 sessions of ISRT, the 24-h BP decreased significantly, whereas no changes were observed in the controls. The BP-lowering effect correlated with the 24-h BP before therapy (systolic: r = -0.78; p < 0.001; diastolic: r = -0.76; p < 0.001). In BP1, the systolic BP decreased by 4.3 ± 6.4 mmHg (p = 0.011), and the diastolic BP decreased by 4.8 ± 11.0 mmHg (p = 0.032); in BP2, the systolic BP decreased by 13.3 ± 7.5 mmHg (p < 0.001), and the diastolic BP decreased by 5.0 ± 7.5 mmHg (p = 0.002); and in BP3, the systolic BP decreased by 22.9 ± 11.4 mmHg (p < 0.001), and the diastolic BP decreased by 9.1 ± 9.5 mmHg (p = 0.003). Our findings demonstrate that ISRT reduces BP in patients with CAD. The higher the initial BP the greater the lowering effect.
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Qin Y, Lü W, Hughes BM, Kaczmarek LD. Trait and state approach-motivated positive affects interactively influence stress cardiovascular recovery. Int J Psychophysiol 2019; 146:261-269. [DOI: 10.1016/j.ijpsycho.2019.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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Acute exposure to nocturnal train noise induces endothelial dysfunction and pro-thromboinflammatory changes of the plasma proteome in healthy subjects. Basic Res Cardiol 2019; 114:46. [PMID: 31664594 PMCID: PMC6817813 DOI: 10.1007/s00395-019-0753-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022]
Abstract
Nocturnal train noise exposure has been associated with hypertension and myocardial infarction. It remains unclear whether acute nighttime train exposure may induce subclinical atherosclerosis, such as endothelial dysfunction and other functional and/or biochemical changes. Thus, we aimed to expose healthy subjects to nocturnal train noise and to assess endothelial function, changes in plasma protein levels and clinical parameters. In a randomized crossover study, we exposed 70 healthy volunteers to either background or two different simulated train noise scenarios in their homes during three nights. After each night, participants visited the study center for measurement of vascular function and assessment of other biomedical and biochemical parameters. The three nighttime noise scenarios were exposure to either background noise (control), 30 or 60 train noise events (Noise30 or Noise60), with average sound pressure levels of 33, 52 and 54 dB(A), respectively. Flow-mediated dilation (FMD) of the brachial artery was 11.23 ± 4.68% for control, compared to 8.71 ± 3.83% for Noise30 and 8.47 ± 3.73% for Noise60 (p < 0.001 vs. control). Sleep quality was impaired after both Noise30 and Noise60 nights (p < 0.001 vs. control). Targeted proteomic analysis showed substantial changes of plasma proteins after the Noise60 night, mainly centered on redox, pro-thrombotic and proinflammatory pathways. Exposure to simulated nocturnal train noise impaired endothelial function. The proteomic changes point toward a proinflammatory and pro-thrombotic phenotype in response to nocturnal train noise and provide a molecular basis to explain the increased cardiovascular risk observed in epidemiological noise studies.
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Validity of transit time–based blood pressure measurements in patients with and without heart failure or pulmonary arterial hypertension across different breathing maneuvers. Sleep Breath 2019; 24:221-230. [DOI: 10.1007/s11325-019-01848-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Picard F, Panagiotidou P, Wolf-Pütz A, Buschmann I, Buschmann E, Steffen M, Klein RM. Usefulness of Individual Shear Rate Therapy, New Treatment Option for Patients With Symptomatic Coronary Artery Disease. Am J Cardiol 2018; 121:416-422. [PMID: 29274808 DOI: 10.1016/j.amjcard.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 01/12/2023]
Abstract
The aim of this study was to elucidate if patients with coronary artery disease (CAD), who fail to respond to revascularization procedures, can improve from individual shear rate therapy (ISRT). The ISRT is an adaptation of the external counterpulsation with lower individual treatment pressures based on Doppler-ultrasound measurements during counterpulsation. In contrast to the external counterpulsation therapy, the ISRT is based on the detection of the individual intra-arterial shear rate. Here we report about the first clinical trial of 31 patients with CAD who were enrolled for 30 sessions of ISRT. To determine the therapeutic effect of ISRT we measured the exercise capacity, the arterial stiffness, the aortic wave reflection, and the 24-hour blood pressure before and after 30 treatment sessions. After 6 weeks of accomplished ISRT the walking distance during the 6-minute walking test extended by 78 m (p = 0.007). The total exercise duration in the exercise stress electrocardiogram increased by 84 seconds (p = 0.012) but not the stress intensity (p = 0.086). The pulse wave velocity decreased by 1.2 m/s (p = 0.004) and demonstrated a decrease in arterial stiffness. Pulse wave analysis results demonstrated a progressive decrease in central blood pressure by 12 mmHg (p = 0.008), in pulse pressure by 9 mmHg (p = 0.005), and in augmentation pressure by 5.3 mmHg (p = 0.004). The 24-hour blood pressure decreased systolic by 15 mmHg (p <0.001) and diastolic by 8 mmHg (p = 0.033). The patients also benefited subjectively followed by New York Heart Association and Canadian Cardiovascular Society classifications. In conclusion, the ISRT is an effective treatment for patients with CAD to improve cardiac fitness, arterial stiffness, and to reduce blood pressure.
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Affiliation(s)
- Frauke Picard
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany.
| | - Petroula Panagiotidou
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Ana Wolf-Pütz
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Ivo Buschmann
- Department for Cardiology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany; Medical University Brandenburg (MHB), Center for Internal Medicine, Department for Angiology, Campus Brandenburg Germany, Germany
| | - Eva Buschmann
- Department for Cardiology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany; Medical University Brandenburg (MHB), Center for Internal Medicine, Department for Angiology, Campus Brandenburg Germany, Germany
| | - Maximilian Steffen
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Rolf Michael Klein
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany; Department of Cardiology, University Hospital Witten/Herdecke, Germany
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Nocturnal blood pressure fluctuations measured by using pulse transit time in patients with severe obstructive sleep apnea syndrome. Sleep Breath 2017; 22:337-343. [PMID: 28828627 DOI: 10.1007/s11325-017-1555-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is related to arterial hypertension. In the present study, we test the hypothesis that patients with severe OSAS have excessive apnea induced blood pressure (BP). METHODS We investigated 97 patients with an apnea/hypopnea index (AHI) greater than 30. Systolic BP (SBP) was continuously determined by using the pulse transit time (PTT). Apnea/hypopnea induced nocturnal BP fluctuations (NBPFs) were detected and showed phenomena of continuous increases of the SBP baseline. Such periods of SBP baseline elevations ≥ 10 mmHg were called superposition. Respiratory and cardiac parameters were obtained from the polysomnographic investigation. RESULTS Eighty-four periods of superposition were detected in 48 patients. They occurred mainly during REM sleep (76%). Apnea duration was increased and the time in respiration was reduced in periods of superposition compared to non-superposition periods. In superposition periods mean oxygen saturation (SpO2) and the minimal SpO2 were lower, desaturations were more pronounced, and the mean heart rate (HR) was increased. The maximum SBP during superposition was significantly increased (204 ± 32 vs.171 ± 28 mmHg). The clinic BP was higher in patients with superposition (SBP 149.2 ± 17.5 vs. 140 ± 19.1, DBP 91.5 ± 11.5 vs. 86.3 ± 11.8). CONCLUSIONS The study reveals that patients with severe OSAS can have periods of BP superposition during night with extremely high SBP and very low oxygen saturation, which may add to a high risk for cardiovascular events during the night.
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Ding X, Zhang Y, Tsang HK. Impact of heart disease and calibration interval on accuracy of pulse transit time-based blood pressure estimation. Physiol Meas 2016; 37:227-37. [PMID: 26767518 DOI: 10.1088/0967-3334/37/2/227] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continuous blood pressure (BP) measurement without a cuff is advantageous for the early detection and prevention of hypertension. The pulse transit time (PTT) method has proven to be promising for continuous cuffless BP measurement. However, the problem of accuracy is one of the most challenging aspects before the large-scale clinical application of this method. Since PTT-based BP estimation relies primarily on the relationship between PTT and BP under certain assumptions, estimation accuracy will be affected by cardiovascular disorders that impair this relationship and by the calibration frequency, which may violate these assumptions. This study sought to examine the impact of heart disease and the calibration interval on the accuracy of PTT-based BP estimation. The accuracy of a PTT-BP algorithm was investigated in 37 healthy subjects and 48 patients with heart disease at different calibration intervals, namely 15 min, 2 weeks, and 1 month after initial calibration. The results showed that the overall accuracy of systolic BP estimation was significantly lower in subjects with heart disease than in healthy subjects, but diastolic BP estimation was more accurate in patients than in healthy subjects. The accuracy of systolic and diastolic BP estimation becomes less reliable with longer calibration intervals. These findings demonstrate that both heart disease and the calibration interval can influence the accuracy of PTT-based BP estimation and should be taken into consideration to improve estimation accuracy.
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Affiliation(s)
- Xiaorong Ding
- Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, People's Republic of China
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Patzak A, Mendoza Y, Gesche H, Konermann M. Continuous blood pressure measurement using the pulse transit time: Comparison to intra-arterial measurement. Blood Press 2015; 24:217-21. [DOI: 10.3109/08037051.2015.1030901] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated-care management approach for the future practice of sleep medicine. Sleep 2015; 38:315-26. [PMID: 25409112 PMCID: PMC4288613 DOI: 10.5665/sleep.4422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 10/10/2014] [Indexed: 11/03/2022] Open
Abstract
ABSTRACT The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. CLINICAL TRIALS NUMBER http://www.clinicaltrials.gov, NCT02037438.
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Affiliation(s)
| | | | | | | | - Kara Griffin
- Sleep Medicine and Research Center, Chesterfield, MO
| | | | | | - Elyse Cohen
- Stanford Sleep Medicine Center, Redwood City, CA
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Validation of blood pressure monitoring using pulse transit time in heart failure patients with Cheyne–Stokes respiration undergoing adaptive servoventilation therapy. Sleep Breath 2013; 18:411-21. [DOI: 10.1007/s11325-013-0895-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/11/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
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17
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Nisbet LC, Yiallourou SR, Biggs SN, Nixon GM, Davey MJ, Trinder JA, Walter LM, Horne RSC. Preschool children with obstructive sleep apnea: the beginnings of elevated blood pressure? Sleep 2013; 36:1219-26. [PMID: 23904682 PMCID: PMC3700719 DOI: 10.5665/sleep.2890] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVES In adults and older children, snoring and obstructive sleep apnea (OSA) are associated with elevated blood pressure (BP). However, BP has not been assessed in preschool children, the age of highest OSA prevalence. We aimed to assess overnight BP in preschool children with snoring and OSA using pulse transit time (PTT), an inverse continuous indicator of BP changes. DESIGN Overnight polysomnography including PTT. Children were grouped according to their obstructive apnea-hypopnea index (OAHI); control (no snoring, with OAHI of one event or less per hour), primary snoring (OAHI one event or less per hour), mild OSA (OAHI greater than one event to five events per hour) and moderate-severe OSA (OAHI more than five events per hour). SETTING Pediatric sleep laboratory. PATIENTS There were 128 clinically referred children (aged 3-5 years) and 35 nonsnoring community control children. MEASUREMENT AND RESULTS PTT was averaged for each 30-sec epoch of rapid eye movement (REM) or nonrapid eye movement (NREM) sleep and normalized to each child's mean wake PTT. PTT during NREM was significantly higher than during REM sleep in all groups (P < 0.001 for all). During REM sleep, the moderate-severe OSA group had significantly lower PTT than the mild and primary snoring groups (P < 0.05 for both). This difference persisted after removal of event-related PTT changes. CONCLUSIONS Moderate-severe OSA in preschool children has a significant effect on pulse transit time during REM sleep, indicating that these young children have a higher baseline BP during this state. We propose that the REM-related elevation in BP may be the first step toward development of daytime BP abnormalities. Given that increased BP during childhood predicts hypertension in adulthood, longitudinal studies are needed to determine the effect of resolution of snoring and/or OSA at this age.
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Affiliation(s)
- Lauren C. Nisbet
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Stephanie R. Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Sarah N. Biggs
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Gillian M. Nixon
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Programme, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Margot J. Davey
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Programme, Monash Medical Centre, Melbourne, Victoria, Australia
| | - John A. Trinder
- Discipline of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa M. Walter
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Rosemary S. C. Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
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Schmidt FP, Basner M, Kröger G, Weck S, Schnorbus B, Muttray A, Sariyar M, Binder H, Gori T, Warnholtz A, Münzel T. Effect of nighttime aircraft noise exposure on endothelial function and stress hormone release in healthy adults. Eur Heart J 2013; 34:3508-14a. [PMID: 23821397 PMCID: PMC3844151 DOI: 10.1093/eurheartj/eht269] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Aircraft noise disturbs sleep, and long-term exposure has been shown to be associated with increases in the prevalence of hypertension and an overall increased risk for myocardial infarction. The exact mechanisms responsible for these cardiovascular effects remain unclear. METHODS AND RESULTS We performed a blinded field study in 75 healthy volunteers (mean age 26 years), who were exposed at home, in random order, to one control pattern (no noise) and two different noise scenarios [30 or 60 aircraft noise events per night with an average maximum sound pressure level (SPL) of 60 dB(A)] for one night each. We performed polygraphy during each study night. Noise caused a worsening in sleep quality (P < 0.0001). Noise60, corresponding to equivalent continuous SPLs of 46.3 dB (Leq) and representing environmental noise levels associated with increased cardiovascular events, caused a blunting in FMD (P = 0.016). As well, although a direct comparison among the FMD values in the noise groups (control: 10.4 ± 3.8%; Noise30: 9.7 ± 4.1%; Noise60: 9.5 ± 4.3%, P = 0.052) did not reach significance, a monotone dose-dependent effect of noise level on FMD was shown (P = 0.020). Finally, there was a priming effect of noise, i.e. the blunting in FMD was particularly evident when subjects were exposed first to 30 and then to 60 noise events (P = 0.006). Noise-induced endothelial dysfunction (ED) was reversed by the administration of Vitamin C (P = 0.0171). Morning adrenaline concentration increased from 28.3 ± 10.9 to 33.2 ± 16.6 and 34.1 ± 19.3 ng/L (P = 0.0099). Pulse transit time, reflecting arterial stiffness, was also shorter after exposure to noise (P = 0.003). CONCLUSION In healthy adults, acute nighttime aircraft noise exposure dose-dependently impairs endothelial function and stimulates adrenaline release. Noise-induced ED may be in part due to increased production in reactive oxygen species and may thus be one mechanism contributing to the observed association of chronic noise exposure with cardiovascular disease.
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Affiliation(s)
- Frank P Schmidt
- Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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Kerl J, Dellweg D, Köhler D. Möglichkeiten und Grenzen der Interpretation von Pulswellen bei der Untersuchung physiologischer Parameter im Schlaflabor. SOMNOLOGIE 2012. [DOI: 10.1007/s11818-012-0596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fiala J, Bingger P, Ruh D, Foerster K, Heilmann C, Beyersdorf F, Zappe H, Seifert A. An implantable optical blood pressure sensor based on pulse transit time. Biomed Microdevices 2012; 15:73-81. [DOI: 10.1007/s10544-012-9689-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Pulse transit time: validation of blood pressure measurement under positive airway pressure ventilation. Sleep Breath 2011; 16:1105-12. [DOI: 10.1007/s11325-011-0609-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 09/28/2011] [Accepted: 10/11/2011] [Indexed: 10/16/2022]
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Gesche H, Grosskurth D, Küchler G, Patzak A. Continuous blood pressure measurement by using the pulse transit time: comparison to a cuff-based method. Eur J Appl Physiol 2011; 112:309-15. [PMID: 21556814 DOI: 10.1007/s00421-011-1983-3] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 04/25/2011] [Indexed: 11/29/2022]
Abstract
Pulse transit time (PTT) and pulse wave velocity (PWV), respectively, were shown to have a correlation with systolic blood pressure (SBP) and have been reported to be suitable for indirect BP measurements. The aim of this study was to create a function between SBP and PWV, and to test its reliability for the determination of absolute SBP using a non-linear algorithm and a one-point calibration. 63 volunteers performed exercise to induce rises in BP. Arterial PTT was measured between the R-spike of the ECG and the plethysmographic curve of finger pulse-oximetry. The reference BP was measured using a cuff-based sphygmomanometric aneroid device. Data from 13 of the 63 volunteers served for the detection of the PWV-BP relationship. The created non-linear function was used to calculate BP values after individual correction for the BP offset in a group of 50 volunteers. Individual correlation coefficients for SBP measured by PTT (SBP(PTT)) and by cuff (SBP(CUFF)) varied between r = 0.69 and r = 0.99. Taking all data together, we found r = 0.83 (276 measurements in 50 volunteers). In the Bland-Altman plot, the limits of agreement were [Formula: see text]± 19.8 mmHg. In conclusion, comparing SBP values using the PTT-based method and those measured by cuff resulted in a significant correlation. However, the Bland-Altman plot shows relevant differences between both methods, which are partly due to greater variability of the SBP(PTT) measurement during intensified exercise. Results suggest that PTT can be used for measuring absolute SBP when performing an individual correction for the offset of the BP-PWV relation.
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Affiliation(s)
- Heiko Gesche
- Institute of Vegetative Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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