Nighttime blood pressure in normotensive subjects with chronic insomnia: implications for cardiovascular risk

Insomnia and sleep duration for kidney function: Mendelian randomization study

OBJECTIVES

Extensive researches highlight the detrimental impact of sleep disorders such as insomnia and insufficient sleep duration on kidney function. However, establishing a clear causal relationship between insomnia, sleep duration, and kidney function remains challenging. This study aims to estimate this relationship using Mendelian randomization (MR).

METHODS

Independent genetic variants strongly associated with insomnia (N = 462,341) and sleep duration (N = 460,099) were selected as instrumental variables from corresponding genome-wide association studies (GWAS). Kidney function parameters, including serum creatinine, estimated glomerular filtration rate by cystatin C (eGFRcys), acute renal failure (ARF), chronic renal failure (CRF), kidney injury molecule-1, neutrophil gelatinase associated lipocalin, microalbuminuria, cystatin C, and β2 microglobulin, were derived from GWAS databases. A two-sample MR study was conducted to assess the causal relationship between sleep disorders and kidney function, and multivariable MR was used to identify potential mediators. The inverse-variance weighted was used as the primary estimate.

RESULTS

MR analysis found robust evidence indicating that insomnia and short sleep duration were associated with an increased risk of elevated serum creatinine, regardless of adjusting for obesity. Causal links between sleep duration and eGFRcys or cystatin C were also identified. While genetically predicted insomnia and sleep duration were found to potentially impact ARF, CRF, microalbuminuria, and β2 microglobulin, the p-values in multivariable MR analysis became nonsignificant. No pleiotropy was detected.

CONCLUSIONS

This study demonstrates a causal impact of insomnia on the risk of elevated serum creatinine and a positive effect of sleep duration on serum creatinine, eGFRcys, and cystatin C. Our findings also suggest their potential indirect effects on ARF, CRF, microalbuminuria, and β2 microglobulin mediated by obesity.

Sex Differences in the Associations Between Chronic Diseases and Insomnia Symptoms Among Older Adults in India

Background

Sleep problems are a critical issue in the aging population, affecting quality of life, cognitive efficiency, and contributing to adverse health outcomes. The coexistence of multiple diseases is common among older adults, particularly women. This study examines the associations between specific chronic diseases, multimorbidity, and insomnia symptoms among older Indian men and women, with a focus on the interaction of sex in these associations.

Methods

Data were drawn from 31,464 individuals aged 60 and older in the Longitudinal Ageing Study in India, Wave-1 (2017-18). Insomnia symptoms were assessed using four questions adapted from the Jenkins Sleep Scale (JSS-4), covering difficulty falling asleep, waking up, waking too early, and feeling unrested during the day. Multivariable logistic regression models, stratified by sex, were used to analyze the associations between chronic diseases and insomnia symptoms.

Results

Older women had a higher prevalence of insomnia symptoms than men (44.73% vs 37.15%). Hypertension was associated with higher odds of insomnia in both men (AOR: 1.20) and women (AOR: 1.36). Women with diabetes had lower odds of insomnia (AOR: 0.80), while this association was not significant in men. Neurological or psychiatric disorders, stroke, and bone and joint diseases were linked to higher odds of insomnia in both sexes. Chronic lung disease was associated with insomnia in men (AOR: 1.65), but not in women. Additionally, having three or more chronic diseases significantly increased the odds of insomnia in both men (AOR: 2.43) and women (AOR: 2.01).

Conclusion

Hypertension, bone and joint diseases, lung diseases, stroke, neurological or psychiatric disorders, and multimorbidity are linked to insomnia symptoms in older Indian adults. Disease-specific management and routine insomnia screening are crucial for promoting healthy aging in this vulnerable population.

Comorbid Insomnia and Sleep Apnea: Challenges and Treatments

Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Therapy can be challenging as treatment of 1 disease may worsen the other. Cognitive behavioral therapy for insomnia is the first-line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA), such as mandibular advancement devices or emerging pharmacotherapies. Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical treatment and utilize a multidisciplinary approach to the treatment of these complex patients.

Association between sleep pattern and incidence of hypertension: A prospective cohort study of older adult participants in the Chinese longitudinal healthy longevity survey

BACKGROUND

The relationship between sleep duration or sleep quality and the risk of hypertension has been previously examined. However, little is known regarding the association between sleep duration and quality and the risk of developing hypertension in the older adult Chinese population.

METHODS

The sleep patterns of 5683 participants without hypertension at baseline from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Cox proportional hazard models were used to study the associations between sleep patterns and hypertension.

RESULTS

It was found that 1712 (30.12%) of the 5683 participants had an unhealthy sleep pattern. After an average follow-up of 3.31 years, 1350 of the participants had hypertension. Compared with participants with an unhealthy sleep pattern, those with a healthy sleep pattern had a 20% (hazard ratio = 0.80, 95% confidence interval = 0.67-0.94, P = = 0.008) lower risk of incident hypertension in the fully adjusted models. In addition, an approximately linear dose-response association was observed between sleep duration and the incidence of hypertension (P for non-linear =0.43). Subgroup analyses demonstrated significant interactions between age and sleep pattern concerning hypertension (P for interaction <0.05). Several sensitivity analyses were conducted, and the obtained findings were similar to the main results.

CONCLUSIONS

A healthy sleep pattern, comprising an adequate sleep duration and good sleep quality, can help reduce hypertension risk. Thus, a healthy sleep pattern is crucial to decreasing hypertension in older Chinese adults in a rapidly aging society.

Comorbid Insomnia and Sleep Apnea: Challenges and Treatments

Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Cognitive behavioral therapy for insomnia is the first line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA). Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical treatment and utilize a multidisciplinary approach.

Circadian Biology and the Neurovascular Unit

Mammalian physiology and cellular function are subject to significant oscillations over the course of every 24-hour day. It is likely that these daily rhythms will affect function as well as mechanisms of disease in the central nervous system. In this review, we attempt to survey and synthesize emerging studies that investigate how circadian biology may influence the neurovascular unit. We examine how circadian clocks may operate in neural, glial, and vascular compartments, review how circadian mechanisms regulate cell-cell signaling, assess interactions with aging and vascular comorbidities, and finally ask whether and how circadian effects and disruptions in rhythms may influence the risk and progression of pathophysiology in cerebrovascular disease. Overcoming identified challenges and leveraging opportunities for future research might support the development of novel circadian-based treatments for stroke.

Cognitive impairment in heart failure patients: association with abnormal circadian blood pressure rhythm: a review from the HOPE Asia Network

Cognitive impairment (CI) is frequently a comorbid condition in heart failure (HF) patients, and is associated with increased cardiovascular events and death. Numerous factors contribute to CI in HF patients. Decreased cerebral blood flow, inflammation, and activation of neurohumoral factors are all thought to be factors that exacerbate CI. Hypoperfusion of the brain due to decreased systemic blood flow, cerebral venous congestion, and atherosclerosis are the main mechanism of CI in HF patients. Abnormal circadian BP rhythm is one of the other conditions associated with CI. The conditions in which BP does not decrease sufficiently or increases during the night are called non-dipper or riser BP patterns. Abnormal circadian BP rhythm worsens CI in HF patients through cerebral congestion during sleep and atherosclerosis due to pressure overload. Interventions for CI in HF patients include treatment for HF itself using cardiovascular drugs, and treatment for fluid retention, one of the causes of abnormal circadian rhythms. Proposed pathways of cognitive impairment in heart failure through abnormal circadian blood pressure rhythm.

The association between child sexual abuse and self-reported sleep in adolescent girls

STUDY OBJECTIVES

Child sexual abuse is associated with negative consequences on both physical and mental health. It has been found to influence child and adolescent sleep, which is an important developmental factor, which also influences mental and physical health. However, the literature examining this topic is plagued by methodological limitations, such as small sample sizes and unvalidated measures.

METHODS

Using the Pittsburgh Sleep Quality Index (PSQI), the present study examined 7 self-reported sleep dimensions, including sleep latency, efficiency, duration, disturbances, subjective sleep quality, daytime dysfunction, and use of sleep medication, in a sample of 707 adolescent girls aged 14-18 years old.

RESULTS

Statistical analyses revealed that child sexual abuse had a significant moderate association with the total PSQI score. Sexually abused adolescent girls, compared with their nonabused counterparts, reported more sleep difficulties. Significant differences also emerged on all sleep dimensions, with abused girls reporting increased difficulties. However, the magnitude of these associations differed from one dimension to another.

CONCLUSIONS

Our findings support the continued study of sleep in adolescent girls who experienced sexual abuse. They also support the use of a fine-grained perspective when assessing various dimensions of sleep health in girls with a history of child sexual abuse for improved tertiary prevention and intervention.

CITATION

Langevin R, Pennestri M-H, Hershon M, Pirro T, Hébert M. The association between child sexual abuse and self-reported sleep in adolescent girls. J Clin Sleep Med. 2023;19(11):1933-1939.

Investigating the causal interplay between sleep traits and risk of acute myocardial infarction: a Mendelian randomization study

BACKGROUND

Few studies have investigated the joint effects of sleep traits on the risk of acute myocardial infarction (AMI). No previous study has used factorial Mendelian randomization (MR) which may reduce confounding, reverse causation, and measurement error. Thus, it is prudent to study joint effects using robust methods to propose sleep-targeted interventions which lower the risk of AMI.

METHODS

The causal interplay between combinations of two sleep traits (including insomnia symptoms, sleep duration, or chronotype) on the risk of AMI was investigated using factorial MR. Genetic risk scores for each sleep trait were dichotomized at their median in UK Biobank (UKBB) and the second survey of the Trøndelag Health Study (HUNT2). A combination of two sleep traits constituting 4 groups were analyzed to estimate the risk of AMI in each group using a 2×2 factorial MR design.

RESULTS

In UKBB, participants with high genetic risk for both insomnia symptoms and short sleep had the highest risk of AMI (hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.03, 1.18), although there was no evidence of interaction (relative excess risk due to interaction (RERI) 0.03; 95% CI -0.07, 0.12). These estimates were less precise in HUNT2 (HR 1.02; 95% CI 0.93, 1.13), possibly due to weak instruments and/or small sample size. Participants with high genetic risk for both a morning chronotype and insomnia symptoms (HR 1.09; 95% CI 1.03, 1.17) and a morning chronotype and short sleep (HR 1.11; 95% CI 1.04, 1.19) had the highest risk of AMI in UKBB, although there was no evidence of interaction (RERI 0.03; 95% CI -0.06, 0.12; and RERI 0.05; 95% CI -0.05, 0.14, respectively). Chronotype was not available in HUNT2.

CONCLUSIONS

This study reveals no interaction effects between sleep traits on the risk of AMI, but all combinations of sleep traits increased the risk of AMI except those with long sleep. This indicates that the main effects of sleep traits on AMI are likely to be independent of each other.

The risk of major adverse cardiovascular events associated with the use of hypnotics in patients with insomnia

OBJECTIVES

To examine whether hypnotic use in patients with insomnia reduces major adverse cardiovascular events, including all-cause mortality and nonfatal major adverse cardiovascular events.

METHODS

Using the Veterans Affairs Corporate Data Warehouse, we conducted a retrospective cohort study of 16,064 patients who were newly diagnosed with insomnia between January 1, 2010, and December 31, 2019. A pair of 3912 hypnotic users and nonusers were selected based on a 1:1 propensity score methodology. The primary outcome was extended major adverse cardiovascular events, a composite of the first occurrence of all-cause mortality or nonfatal major adverse cardiovascular events.

RESULTS

During the median follow-up of 4.8 years, a total of 2791 composite events occurred, including 2033 deaths and 762 nonfatal major adverse cardiovascular events. Although the incidence rates of major adverse cardiovascular events were comparable between hypnotic users and nonusers in the propensity-matched cohort, users of benzodiazepines and Z-drugs had a higher risk of all-cause mortality (hazard ratio 1.47 [95% CI, 1.17-1.88] and 1.20 [95% CI, 1.03-1.39], respectively), while serotonin antagonist and reuptake inhibitors users had a survival advantage (hazard ratio 0.79 [95% CI, 0.69-0.91]) compared with nonusers. There were no differences in the risk of nonfatal major adverse cardiovascular events between all classes of hypnotics. Male patients and those aged 60 years or younger who were using benzodiazepines or Z-drugs experienced higher major adverse cardiovascular events than their counterparts.

CONCLUSIONS

In patients with newly diagnosed insomnia, treatment with hypnotics resulted in higher extended major adverse cardiovascular events but not nonfatal major adverse cardiovascular events with benzodiazepine and Z-drug users compared with nonusers. The use of serotonin antagonist and reuptake inhibitors agents had a protective effect against major adverse cardiovascular events warranting further investigation.

A Systematic Review of Publications on the Associations Between Sleep Architecture and Arterial Hypertension

Sleep research has garnered substantial interest among scientists owing to its correlation with various diseases, particularly elevated blood pressure observed in patients with obstructive sleep apnea. This systematic review aims to identify and analyze publications exploring the associations between sleep architecture and arterial hypertension. A comprehensive search of PubMed (MEDLINE), Scopus, and Embase databases yielded 111 reports, of which 7 manuscripts were included in the review. Four of the studies reported a significant reduction in the duration of the N3 phase of sleep in hypertensive patients, while 2 studies found a statistically significant reduction in the duration of the N2 and rapid eye movement (REM) stages of sleep. Three studies indicated increased sleep fragmentation in hypertensive patients. They showed a longer duration of the N1 stage of sleep, shorter duration of overall sleep time, and an increased apnea-hypopnea index in hypertensive patients. These findings underscore the association between the duration of non-REM/REM sleep stages and elevated BP, providing substantial evidence. Moreover, a notable increase in sleep fragmentation was observed among patients with hypertension. However, further research is warranted to expand and deepen our understanding of this intricate relationship. This systematic review serves as a valuable resource, guiding future investigations and contributing to advancements in the field of sleep and arterial hypertension.

The association between sleep disturbances and blood pressure variability: a review of the literature

STUDY OBJECTIVES

Sleep disturbances are an underrecognized public health issue that results in various adverse outcomes and disturbed quality of life. Blood pressure variability (BPV) is an emerging entity in assessing cardiovascular disease risk and accumulating evidence suggests that BPV is closely associated with end-organ damage. This review aims to explore the association between sleep disturbances and BPV.

METHODS

A comprehensive systematic literature search was conducted electronically using Web of Science, Ovid MEDLINE, , and SCOPUS. The electronic search was restricted to relevant English-language studies published between 1985 and August 2020. Most studies were prospective cohorts in design. After applying eligibility criteria, 29 articles were included for synthesis.

RESULTS

This review shows that sleep disturbances are linked to short-term, midterm, and long-term BPV. Restless legs syndrome, shift work, insomnia, short sleep, long sleep, obstructive sleep apnea, and sleep deprivation were all positively associated with systolic blood pressure or diastolic blood pressure fluctuations.

CONCLUSIONS

Given the prognostic implications of BPV and sleep disturbances on cardiovascular mortality, recognizing and treating both disorders is essential. More research is needed to examine the impact of sleep disorder treatment on BPV and cardiovascular mortality.

CITATION

Al Haddad N, Costanian C, Zibara V, et al. The association between sleep disturbances and blood pressure variability: a review of the literature. J Clin Sleep Med. 2023;19(8):1533-1544.

Non-Traditional Risk Factors as Contributors to Cardiovascular Disease

Cardiovascular disease (CVD) remains one of the primary causes of morbidity and mortality worldwide. Classic cardiovascular risk factors, such as hypertension, diabetes mellitus (DM), hyperlipidemia, and smoking, have been well identified and given increased attention in clinical practice. However, the incidence and prevalence of CVD remains high, especially in developing countries. Therefore, there has been more attention to non-traditional CVD risk factors such as gut microbiota, sleep disorders, dietary structure, and psychosocial factors in their important roles in the development of CVD. In this review we summarize the association of non-traditional risk factors with CVD with the aim of further reducing the risk of CVD.

Relationships between the Pittsburgh Sleep Quality Index (PSQI) and vertigo outcome

OBJECTIVE

This retrospective cohort study aimed to investigate the association of sleep characteristics measured by the Pittsburgh Sleep Quality Index (PSQI) with the vertigo outcome in vertiginous patients with comorbid cardiometabolic diseases.

METHODS

Four hundred and thirteen patients with comorbid cardiometabolic diseases who consecutively visiting vertigo and dizziness clinic were enrolled between October 2018 and January 2020 in a tertiary teaching medical center. Regression analyses and stratified analyses were used to explore the relationship between PSQI and vertigo outcome, which was measured by the visual analogue scale (VAS) score.

RESULTS

In the study sample, 73.8% (305/413) were defined as 'poor sleep' (PSQI>5). Participants with better recovery tended to have better baseline PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI daytime dysfunction, less severe baseline vertigo symptoms indicated by VAS, Vertigo Symptom Scale (VSS) and Dizziness Handicap Inventory (DHI) scores. Moreover, baseline PSQI global score and PSQI daytime dysfunction score were independently associated with the vertigo VAS scores at the last follow-up.

CONCLUSION

The present results clearly indicated that poor sleep is common and inversely associated with vertigo outcome in vertiginous patients with co-morbid cardiometabolic diseases. Therefore, sleep deserves greater attention in the total medical care in specific subgroup of vertiginous patients.

The importance of sleep patterns in the incidence of coronary heart disease: a 6-year prospective study in Mashhad, Iran

Chronic shortened sleep can increase several cardiovascular risk factors, including depression, anxiety, metabolic syndrome, diabetes and hypertension. In the current study, we aimed to investigate the relationship between sleep patterns and the incidence of coronary heart disease (CHD). A total of 9704 healthy participants were recruited for the MASHAD cohort study. Within 6 years of follow-up, participants were categorized into four groups based on their number of hours of nightly sleep. Cox's proportional hazard model was used to assess relative risks (RRs) and 95% confidence intervals (CIs). During the study, 235 heart problems, including myocardial infarction, stable angina and unstable angina, were confirmed. There were significant differences between men and women who had short and long nightly sleep (p < 0.05). The incidence of CHD was significantly higher in participants with very short night sleep durations than in those with longer hours of night sleep. The subjects with very short nightly sleep were more susceptible to unstable angina (RR: 2.614 (CI 1.354-5.047)) (p < 0.05). We found that shortened nightly sleep was associated with an increased incidence of coronary heart disease in an Iranian population. These findings suggest that sleep disorders, especially shortened night sleep, can be a risk factor for CHD.

Poor Sleep Quality in Aging: The Association with Mental Health

Sleep disturbances are common in the elderly. A primary sleep disorder can result from the physiological decline of aging; however, secondary sleep problems result from various causes involving physical and mental health. Since little is known about the relationships between sleep quality and mental health in aging, the present study aims to understand how different aspects generally associated with sleep (e.g., psychological and physiological factors, and sleep medication) may predict poor sleep quality in different stages of the lifespan. Therefore, we conducted several analyses (ANOVAs, Pearson correlations, and linear regressions) to test the hypotheses of the study. Accordingly, from a pool of 180 participants (elderly, middle-aged, and young adults), 143 individuals with poor sleep quality were selected. Different predictive patterns in the three groups emerged. Specifically, the use of sleep medication associated with worse sleep conditions is predicted by poor sleep quality in the elderly and by depression in young adults. In contrast, worsening sleep quality is predicted by depression in middle-aged adults. Previous studies focused on the transitions from good to poor sleep quality, while this is the first study to have examined the features of poor sleep quality in aging, highlighting different sleep patterns across the lifespan. This evidence should be considered from a preventive perspective.

Sleep and Circadian Disturbance in Cardiovascular Risk

PURPOSE OF REVIEW

We discuss the relationship between sleep and circadian factors with cardiovascular disease (CVD) risk, including physiologic, behavioral, and psychological mechanisms along this pathway.

RECENT FINDINGS

The relationship between short and long sleep duration, as well as insomnia, with CVD risk is well-established. Recent work has highlighted how other sleep factors, such as sleep regularity (i.e., consistency of sleep timing), multidimensional sleep health, and circadian factors like chronotype and social jetlag, relate to CVD risk. Sleep-focused interventions (e.g., cognitive behavioral therapy for insomnia and sleep extension) may be effective to reduce CVD risk and disease burden. Sleep is increasingly recognized as an integral component of cardiovascular health. This was underscored by the recent inclusion of sleep duration as a health behavior in the American Heart Association's Life's Essential 8 for defining optimal cardiovascular health.

The Effects of Insomnia and Sleep Loss on Cardiovascular Disease

Sleep loss has negative impacts on quality of life, mood, cognitive function and heath. Insomnia or difficulty sleeping is also a prevalent issue, affecting up to 35% of the population at some point in their lives. Insomnia is linked to poor mood, increased use of health care resources, and decreased quality of life as well as possible links to cardiovascular risk factors and disease. Studies have shown an increase in cortisol levels, decreased immunity, and increased markers of sympathetic activity in sleep-deprived healthy subjects and those with chronic insomnia. The literature also shows that subjective complaints consistent with chronic insomnia and shortened sleep time, both independently and in combination, can be associated with the development of diabetes, hypertension, and cardiovascular disease. In this article, we will explore the relationship and strength of association between insufficient sleep and insomnia with these health conditions.

Sleep Deficiency in Obstructive Sleep Apnea

Sleep deficiency in patients with obstructive sleep apnea includes abnormal quality, timing, and duration of sleep, and the presence of other comorbid conditions. These include insomnia, circadian misalignment disorders, and periodic limb movements of sleep. The co-occurrence of these conditions with obstructive sleep apnea likely plays a role in the pathogenesis, clinical presentation, and management of obstructive sleep apnea. Considering these conditions and their treatment in evaluating sleep deficiency in obstructive sleep apnea may help to improve patient outcomes. However, future research is needed to understand the intersection between obstructive sleep apnea and these disorders.

Associations between Sleep Quality and Heart Rate Variability: Implications for a Biological Model of Stress Detection Using Wearable Technology

INTRODUCTION

The autonomic nervous system plays a vital role in the modulation of many vital bodily functions, one of which is sleep and wakefulness. Many studies have investigated the link between autonomic dysfunction and sleep cycles; however, few studies have investigated the links between short-term sleep health, as determined by the Pittsburgh Quality of Sleep Index (PSQI), such as subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction, and autonomic functioning in healthy individuals.

AIM

In this cross-sectional study, the aim was to investigate the links between short-term sleep quality and duration, and heart rate variability in 60 healthy individuals, in order to provide useful information about the effects of stress and sleep on heart rate variability (HRV) indices, which in turn could be integrated into biological models for wearable devices.

METHODS

Sleep parameters were collected from participants on commencement of the study, and HRV was derived using an electrocardiogram (ECG) during a resting and stress task (Trier Stress Test).

RESULT

Low-frequency to high-frequency (LF:HF) ratio was significantly higher during the stress task than during the baseline resting phase, and very-low-frequency and high-frequency HRV were inversely related to impaired sleep during stress tasks.

CONCLUSION

Given the ubiquitous nature of wearable technologies for monitoring health states, in particular HRV, it is important to consider the impacts of sleep states when using these technologies to interpret data. Very-low-frequency HRV during the stress task was found to be inversely related to three negative sleep indices: sleep quality, daytime dysfunction, and global sleep score.

Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic

BACKGROUND

Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.

METHODS

A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.

RESULTS

Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near-statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068).

CONCLUSIONS

Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.

Association between insomnia and subclinical atherosclerosis among Chinese steelworkers: a cross-sectional survey

Background

Insomnia is a common prevalent sleep disorder. Difficulty maintaining sleep or poor in quality in insomnia caused by disrupted or misaligned circadian rhythms may play an important role in the development of atherosclerosis. This study aimed to examine the association between insomnia and subclinical atherosclerosis in Chinese steelworkers.

Methods

A total of 3240 subjects from a large enterprise located in northern China were included in this study. The Athens Insomnia Scale (AIS) was used to assess the status of insomnia. Subclinical atherosclerosis was evaluated using ultrasonographic measurements of carotid plaque. Multivariable logistic regression was used to identify association between insomnia and carotid atherosclerosis.

Results

The overall prevalence of insomnia and carotid plaque were 35.3 and 31.7% in the study population. Compared with non-insomnia workers, significantly increased odds of carotid plaque were observed among insomnia workers after adjusting for potential confounders, odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.17 to 1.63. Exposure to current shift work and insomnia simultaneously can significantly elevated the odds of carotid plaque.

Conclusion

Insomnia is associated with elevated odds of carotid atherosclerosis in male steelworkers. Insomnia problems of workers should receive further attention in occupational worker health interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00834-1.

Sympathetic neural responses to sleep disorders and insufficiencies

Short sleep duration and poor sleep quality are associated with cardiovascular risk, and sympathetic nervous system (SNS) dysfunction appears to be a key contributor. The present review will characterize sympathetic function across several sleep disorders and insufficiencies in humans, including sleep deprivation, insomnia, narcolepsy, and obstructive sleep apnea (OSA). We will focus on direct assessments of sympathetic activation, e.g., plasma norepinephrine and muscle sympathetic nerve activity, but include heart rate variability (HRV) when direct assessments are lacking. The review also highlights sex as a key biological variable. Experimental models of total sleep deprivation and sleep restriction are converging to support several epidemiological studies reporting an association between short sleep duration and hypertension, especially in women. A systemic increase of SNS activity via plasma norepinephrine is present with insomnia and has also been confirmed with direct, regionally specific evidence from microneurographic studies. Narcolepsy is characterized by autonomic dysfunction via both HRV and microneurographic studies but with opposing conclusions regarding SNS activation. Robust sympathoexcitation is well documented in OSA and is related to baroreflex and chemoreflex dysfunction. Treatment of OSA with continuous positive airway pressure results in sympathoinhibition. In summary, sleep disorders and insufficiencies are often characterized by sympathoexcitation and/or sympathetic/baroreflex dysfunction, with several studies suggesting women may be at heightened risk.

A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study

BACKGROUND

Poor sleep is associated with increased hypertension risk, but few studies have evaluated multiple sleep dimensions or investigated racial/ethnic disparities in this association among women.

METHOD

We investigated multiple sleep dimensions (sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping and difficulty falling or staying asleep) and hypertension risk among women, and determined modification by age, race/ethnicity and menopausal status. We used data from the Sister Study, a national cohort of 50 884 women who had sisters diagnosed with breast cancer in the United States enrolled in 2003-2009 and followed through September 2018.

RESULTS

Of 33 497 women without diagnosed hypertension at baseline (mean age ± standard deviation: 53.9 ± 8.8 years; 88.7% White, 6.4% Black and 4.9% Hispanic/Latina), 23% (n = 7686) developed hypertension over a median follow-up of 10.1 years [interquartile range: 8.2-11.9 years]. Very short, short or long sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping, insomnia, insomnia symptoms as well as short sleep and exploratory cumulative poor sleep score were associated with incident hypertension after adjustment for demographics factors. After additional adjustment for lifestyle and clinical factors, insomnia [hazard ratio = 1.09, 95% confidence interval (95% CI): 1.03-1.15] and insomnia symptoms plus short sleep (hazard ratio = 1.13, 95% CI: 1.05-1.21) remained associated with incident hypertension. These associations were stronger in younger (age<54 vs. ≥54 years) and premenopausal vs. postmenopausal women (all P-interaction < 0.05). Associations did not differ by race/ethnicity (all P-interaction > 0.05).

CONCLUSION

Thus, screening for multiple sleep dimensions and prioritizing younger and premenopausal women may help identify individuals at high risk for hypertension.

Is there any relation between arterial stiffness and insomnia? A challenging question

PURPOSE

Insomnia is a common sleep disorder which has high comorbidity with a number of cardiovascular diseases (CVD). As a possible risk factor for the CVDs, arterial stiffness may be assessed non-invasively by pulse wave velocity (PWV) and augmentation index (AI). The aim of this study was to evaluate any relation between insomnia and arterial stiffness.

METHODS

Patients with insomnia were included in the study after the exclusion of other sleep disorders by polysomnography. Sleep quality and the degree of insomnia symptoms were evaluated by the Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI), respectively. PWV and AI were assessed by Mobil-O-Graph arteriograph system.

RESULTS

Consecutive patients with insomnia (n = 72, 56 women, mean age 55.8 ± 9.1 years) were included. Patients were grouped as those with severe ISI scores (22-28) and those with mild to moderate ISI scores (8-21). Despite no significant difference in characteristics and clinical data, patients with severe ISI scores had significantly higher total PSQI scores and NREM-2 with significantly lower REM duration. They also had significantly higher systolic blood pressure, mean blood pressure, pulse pressure, PWV, and AI compared to patients with mild and moderate ISI scores. Correlation analysis revealed that PWV and AI were significantly correlated with the ISI score and PSQI score.

CONCLUSION

There is a close relation between arterial stiffness and insomnia suggesting a risk for CVD in patients with insomnia.

Cardiopulmonary coupling-derived sleep quality is associated with improvements in blood pressure in patients with obstructive sleep apnea at high-cardiovascular risk

OBJECTIVE

Investigate if changes in objective sleep quality index (SQI) assessed through cardiopulmonary-coupling analysis impacts blood pressure (BP) in patients with obstructive sleep apnea at high-cardiovascular risk.

METHODS

Secondary analysis of ECG and pulse-oximetry-[oxygen saturation (SpO2)] data from the Heart Biomarker Evaluation in Apnea Treatment study, multicenter, controlled trial in patients with cardiovascular disease and moderate-severe obstructive sleep apnea, randomly assigned to intervention of healthy lifestyle and sleep hygiene education (HLSE; control group), continuous positive airway pressure (CPAP) or nocturnal supplemental oxygen (NSO). Participants with good-quality ECG-signal and SpO2-signal (n = 241) were included.

RESULTS

CPAP-therapy significantly improved BP, with net average improvement in mean arterial blood pressure during sleep (MAP) when compared with nocturnal supplemental oxygen-therapy or healthy lifestyle and sleep education-therapy, -3.92 (P = 0.012) and -3.83 (P = 0.016), respectively. When stratified on the basis of baseline-SQI, CPAP-therapy improves 24-h MAP -3.02 (P = 0.030) and MAP -5.00 (P = 0.001), in patients with compromised baseline-SQI (SQI < 55). Stratifying the cohort based on changes in SQI during the study period (SQI-SQI), controlling for sex, age over 60, apnea-hypopnea index, SpO2 less than 80%, baseline BP and cardiovascular disease, significant differences are observed comparing the groups that Improved-SQI (SQI < 55, SQI ≥ 55) and Declined-SQI (SQI ≥ 55, SQI < 55) in MAP -4.87 (P = 0.046) and mean diastolic blood pressure (MDP) -4.42 (P = 0.026) as well as MAP -6.36 (P = 0.015), mean systolic blood pressure wake (MSP) -7.80 (P = 0.048) and MDP -5.64 (P = 0.009), respectively. Improved SQI reflects the magnitude of positive effect on BP which is reached mostly through initiation of CPAP-therapy.

CONCLUSION

Cardiopulmonary coupling-derived sleep quality impacted 24-h MAP and MDP, as well as BP during wake, in patients participating in the Heart Biomarker Evaluation in Apnea Treatment-study.

The Epidemiology of Insomnia and Sleep Duration Across Mental and Physical Health: The SHoT Study

Objective

Numerous epidemiological studies have been conducted to examine the prevalence and comorbidities of insomnia and document sleep duration, but a common limitation in many studies is the lack of use of agreed-upon definitions of insomnia, as well as insufficient statistical power to examine comorbid mental and physical disorders/conditions.

Aim

To examine the prevalence of insomnia operationalized according to formal DSM-5 criteria and differences in mean sleep duration across a wide range of mental and physical disorders, examining men and women separately.

Materials and Methods

Data stem from the SHoT study (Students' Health and Wellbeing Study), a national survey of all college and university students in Norway. In all, 162,512 students aged 18-35 received an invitation to participate, of whom 50,054 students completed the internet-based survey (attendance rate: 30.8%). Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria and sleep duration was calculated separately for weekdays and weekends. Self-reported mental and physical disorders/conditions were assessed using a pre-defined list modified to fit this age group. Pearson chi-squared tests were used to examine the prevalence of insomnia across the various mental and physical disorders/conditions in men and women separately, and log-link binomial regression analysis were used to calculate effect-sizes, adjusting for age.

Results

The prevalence of insomnia in both sexes was significantly higher across all mental disorders compared with a healthy reference group. Among females, the prevalence of insomnia ranged from 61.3% for comorbid depression (adj. RR = 2.49, 95% CI: 2.40) to 83.3% for comorbid schizophrenia (adj. RR = 3.37, 95% CI: 2.61-4.35). For males, the insomnia prevalence ranged from 32.3% for comorbid autism/Asperger (adj. RR = 2.02, 95% CI: 1.39-2.92) to 74.2% for comorbid eating disorder (adj. RR = 4.51, 95% CI: 3.87-5.27). The overall prevalence of insomnia was also significantly higher across most physical conditions compared with the healthy reference group, although generally lower compared to the mental disorders. For females, the insomnia prevalence ranged from 25% for comorbid multiple sclerosis (not significant) to 65.4% for comorbid chronic fatigue syndrome/ME (adj. RR = 2.66, 95% CI: 2.44-2.89). For males, the insomnia prevalence ranged from 20% for both comorbid cancer and diabetes (not significant) to 74.2% for comorbid fibromyalgia (adj. RR = 4.35, 95% CI: 2.96-6.39). Similar patterns were observed for sleep duration, with a significantly shorter sleep duration for across many physical disorders, but especially mental disorders.

Conclusion

Insomnia and short sleep duration are strongly associated with a range of different disorders and conditions. Insomnia is most strongly associated with mental disorders, and physical conditions characterized by some level of psychological or psychosomatic properties.

Effects of insomnia and restless legs syndrome on sleep arterial blood pressure: A systematic review and meta-analysis

Hypertension and blunted blood pressure (BP) dipping during nighttime sleep are associated with increased cardiovascular risk. Chronic insomnia and restless legs syndrome (RLS) may affect the 24-h BP profile. We systematically reviewed the association of insomnia and RLS with BP values during nighttime sleep and the relative BP dipping pattern. We searched relevant articles in any language with selection criteria including enrolment of subjects with insomnia or RLS and with obstructive sleep apnea comorbidity assessment. Of the 872 studies originally retrieved, seven were selected. Four studies enrolled subjects with insomnia. One study relied on sleep diaries to classify nighttime sleep BP, whereas three relied only on clock time. At meta-analysis, subjects with insomnia displayed an attenuated dipping of systolic BP (-2.00%; 95% confidence interval (CI): -3.61 - -0.39%) and diastolic BP (-1.58%; 95% CI: -2.66 ̶ -0.49%) during nighttime sleep compared to controls. Three studies enrolled subjects with RLS. One study relied on polysomnography to classify nighttime sleep BP, whereas two relied only on clock time. Subjects with RLS showed increases in nighttime sleep systolic BP (5.61 mm Hg, 95% CI 0.13̶-11.09 mm Hg) compared to controls. In conclusion, the limited available data suggest that insomnia and RLS are both associated with altered BP control during nighttime sleep. There is need for more clinical studies to confirm these findings, specifically focusing on measurements of BP during objectively defined sleep, on causal roles of leg movements during sleep and alterations in sleep architecture, and on implications for cardiovascular risk. PROSPERO ACKNOWLEDGEMENT OF NUMBER: CRD42020217947.

The role of insomnia in the association between posttraumatic stress disorder and hypertension

OBJECTIVE

Posttraumatic stress disorder (PTSD) is associated with incident hypertension. Although this relationship is poorly understood, PTSD is also associated with insomnia symptoms, which increases the risk for hypertension. Whether insomnia contributes to PTSD-associated risk for hypertension is unknown.

METHODS

We examined self-report survey and electronic health record data from 1109 participants in the Women Veterans Cohort Study (mean age: 43.8 ± 10.9 years; 52% women, 81% White) to assess the cross-sectional associations between PTSD symptom severity, recent symptoms of insomnia, and hypertension, defined as self-reported treatment for high blood pressure in the last year. Structural equation modeling was used to examine whether insomnia symptoms mediate the association between PTSD and hypertension.

RESULTS

PTSD symptom severity was associated with hypertension (r = 0.09, P < 0.001). PTSD symptom severity and hypertension were each associated with the insomnia symptoms difficulty falling asleep, difficulty staying asleep, and worry/distress about sleep problems (PTSD: rs = 0.58--0.62, P <  0.001; hypertension: rs = 0.07--0.10, P <  0.001). A latent variable derived from those symptoms mediated 9% of the association between PTSD symptom severity and hypertension (P = 0.02).

CONCLUSION

In this study of young and middle-aged Veterans, insomnia symptoms mediated the association between PTSD and hypertension. Difficulties falling asleep and maintaining sleep and related distress may be particularly deleterious for cardiovascular health in Veterans. Longitudinal data is required to further investigate the associations between PTSD, insomnia, and hypertension.

Light therapy improves diurnal blood pressure control in night shift workers via reduction of catecholamines: the EuRhythDia study

OBJECTIVES

Night shift work is associated with high rates of hypertension and cardiometabolic disease, which are linked to disrupted circadian rhythms. We hypothesized that timed light therapy might improve disrupted circadian rhythms and stabilize diurnal control of blood pressure and glucose in night shift workers.

METHODS

We randomized 24 rotating night shift workers (mean age, 36 ± 13 years, 7 men) who had spent a median of 6 years on rotating night shifts (median, six night shifts per month) to 12 weeks of light therapy or no intervention and compared them with 12 daytime workers (37 ± 11 years, 6 men). We measured oral glucose tolerance (OGTT), 24-h blood pressure and arterial stiffness, and the circadian profiles of melatonin, cortisol, metanephrine and nor-metanephrine at baseline, after 12 weeks of intervention, and 12 weeks after the end of intervention.

RESULTS

At baseline, fewer night shift workers showed dipper status as compared with daytime workers (29 vs. 58%; P < 0.001). After 12 weeks of light therapy, there was a highly significant increase in the proportion of dippers (to 58%; P < 0.0001). We also observed a significant decrease in serum glucose during OGTT in the light therapy group (-22%; P < 0.05) with no change in serum insulin. Whilst circadian profiles of melatonin and cortisol were unchanged, plasma metanephrine and nor-metanephrine levels were significantly reduced in the light therapy group (P < 0.01).

CONCLUSION

Timed light therapy improves diurnal blood pressure control and glucose tolerance in rotating night shift workers. This effect is unrelated to melatonin and cortisol but is paralleled by reduced catecholamine levels.

Diagnostic and Therapeutic Approach to Sleep Disorders, High Blood Pressure and Cardiovascular Diseases: A Consensus Document by the Italian Society of Hypertension (SIIA)

Hypertension is a major contributor to fatal/nonfatal cardiovascular diseases, and timely identification and appropriate management of factors affecting hypertension and its control are mandatory public health issues. By inducing neurohormonal alterations and metabolic impairment, sleep disorders have an impact on a variety of cardiovascular risk factors, including hypertension, and ultimately increase the risk of cardiovascular events. There is evidence that qualitative and quantitative sleep disorders are associated with resistant hypertension and with impaired circadian blood pressure variations. However, sleep disturbances are often unrecognized, or heterogeneity exists in their management by non-specialists in the field. This document by the Italian Society of Hypertension summarizes the updated evidence linking sleep disorders to hypertension and cardiovascular diseases, the major underlying mechanisms, and the possible management strategies. A simplified, evidence-based diagnostic and therapeutic algorithm for comorbid hypertension and common sleep disorders, namely obstructive sleep apnoea and insomnia, is proposed.

Blood pressure dipping and sleep quality in the Wisconsin Sleep Cohort

AIMS

Nondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample.

METHODS

A subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately.

RESULTS

In cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3-3.5) for 1-h longer waking after sleep onset, 2.1 (1.1-5.1) for 7-8 h total sleep time, and 3.7 (1.3-10.7) for at least 8-h total sleep time (compared with total sleep time 6-7 h), and 1.9 (1.1-3.4) for sleep efficiency less than 0.8, respectively.

CONCLUSION

Clinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.

Incidence, Persistence, and Remission Rates of Insomnia Over 5 Years

IMPORTANCE

Insomnia is a significant public health problem, but there is little information on its natural history.

OBJECTIVE

To assess the incidence, persistence, and remission rates of insomnia over a 5-year naturalistic follow-up period.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included participants with and without sleep problems selected from the adult population in Canada from August 2007 to June 2014. Participants completed an annual survey about their sleep and health status for 5 consecutive years.

EXPOSURE

Using validated algorithms, participants were classified at each assessment as being good sleepers (n = 1717), having an insomnia disorder (n = 538), or having subsyndromal insomnia (n = 818).

MAIN OUTCOMES AND MEASURES

Survival analyses were used to derive incidence rates of new insomnia among the subgroup of good sleepers at baseline and persistence and remission rates among those with insomnia at baseline. Sleep trajectories were examined by looking at year-person transitions between each consecutive year summed over the 5-year follow-up period. All inferential analyses were weighted according to normalized sampling weights.

RESULTS

The sample included 3073 adults (mean [SD] age, 48.1 [15.0] years; range, 18.0-95.0 years; 1910 [62.2%] female). Overall, 13.9% (95% CI, 11.0%-17. 5%) of initial good sleepers developed an insomnia syndrome during the 5-year follow-up period, and incidence rates were higher among women than among men (17.6% [95% CI, 13.6%-22.7%] vs 10.1% [95% CI, 6.6%-15.3%; χ2  = 4.43; P = .03). A total of 37.5% (95% CI, 32.6%-42.5%) of participants with insomnia at baseline reported insomnia persisting at each of the 5 annual follow-up times. For subsyndromal insomnia, rates were 62.5% at 1 year to 26.5% at 5 years. For syndromal insomnia, rates were 86.0% at 1 year to 59.1% at 5 years. Conversely, remission rates among those with subsyndromal insomnia were almost double the rates among those with an insomnia syndrome at 1 year (37.5% [95% CI, 31.7%-44.0%] vs 14.0% [95% CI, 9.3%-20.8%]), 3 years (62.7% [95% CI, 56.7%-68.7%] vs 27.6% [95% CI, 20.9%-35.9%]), and 5 years (73.6% [95% CI, 68.0%-78.9%%] vs 40.9% [95% CI, 32.7%-50.4%]). Yearly trajectories showed that individuals who were good sleepers at baseline were 4.2 (95% CI, 3.51-4.89) times more likely to stay good sleepers in the subsequent year, but once they developed insomnia, they were equally likely to report symptoms (47% probability) than to return to a good sleeper status (53% probability) 1 year later. Similarly, those with an insomnia syndrome at any given assessment were more likely (adjusted odds ratio, 1.60; 95% CI, 1.19-2.60) to remain in that status (persistence) than to improve (remittance) at the next assessment; even among those who improved, the odds of relapse were greater (adjusted odds ratio, 2.04; 95% CI, 1.23-3.37) than those to improve in the following year.

CONCLUSIONS AND RELEVANCE

The findings suggest that insomnia is often a persistent condition. Considering the long-term adverse outcomes associated with persistent insomnia, these findings may have important implication for the prognosis and management of insomnia.

Lifestyle interventions for the prevention and treatment of hypertension

Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.

Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?-a narrative review

Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Current evidence supports the treatment of high blood pressure (BP) values in order to obtain a substantial reduction of cardiovascular burden. Sleep plays an important role in maintaining nocturnal BP control and nocturnal hypertension which, in turn, can be affected by the presence of sleep disorders. Whilst respiratory disturbances have been extensively studied and their causal role in the development of nocturnal hypertension has been demonstrated in both cross sectional and prospective studies, less is known about the impact of other sleep disorders such as insomnia. In this review, we aim to describe the role of sleep disorders in the development of nocturnal and diurnal hypertension. Furthermore, we aim to discuss the potential impact of the treatment of such sleep disorders on BP values as an adjunct treatment for patients with hypertension.

Increased Blood Pressure Dipping in Restless Legs Syndrome With Rotigotine: A Randomized Trial

OBJECTIVE

The objective of this study was to assess the rotigotine effect on the nocturnal blood pressure (BP) dip by 24-hour ambulatory BP monitoring and on endothelial function in patients with restless legs syndrome (RLS) compared with placebo.

METHODS

In this double-blind, placebo-controlled trial, 76 adult patients with moderate to severe RLS and periodic legs movements in sleep index ≥10/hour were randomized to rotigotine at optimal dose of 3 mg per day or placebo for 6 weeks. A total of 6 patients had a major protocol deviation. Polysomnography, ambulatory BP monitoring, and endothelial function were assessed at baseline and end point. The primary outcome was the between-group difference in the percentage of BP nondipper profiles at end point. The main secondary outcomes were the mean BP dip, periodic legs movements in sleep index, and endothelial function.

RESULTS

Of the 70 patients (age, 59.4 ± 11.40; 43 women) randomized to rotigotine (n = 34) and placebo (n = 36), 66 (33 rotigotine, 33 placebo) completed the study. The percentage of BP nondippers at end point was higher in the placebo than in the rotigotine group (systolic BP, 72.22% vs 47.06%; diastolic BP, 47.22% vs 20.59%; P < 0.05). Mean BP dip at end point was higher in the rotigotine than in the placebo group (systolic BP, 11.24 ± 6.15 vs 6.12 ± 7.98; diastolic BP, 15.12 ± 7.09 vs 9.36 ± 10.23; P < 0.05). Endothelial function was comparable between the groups. No significant safety concerns were reported with similar incidences of adverse events between groups.

CONCLUSION

Rotigotine increased the percentage of BP dipper profiles and the BP dip in patients with RLS. Future studies should assess whether this change is associated with a reduction in the long-term cardiovascular risk in RLS. © 2020 International Parkinson and Movement Disorder Society.

Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men

Chronically blunted nocturnal blood pressure (BP) dipping has been shown to increase the future risk of cardiovascular diseases. In the present cross-sectional study, we investigated whether self-reported insomnia symptoms were associated with an altered 24-h BP profile and blunted nocturnal BP dipping (night-to-day BP ratio > 0.90) in older men. For the analysis, we used 24-h ambulatory blood pressure data and reports of insomnia symptoms (difficulty initiating sleep, DIS; and early morning awakenings, EMA) from 995 Swedish men (mean age: 71 years). Compared to men without DIS, those reporting DIS (10% of the cohort) had a higher odds ratio of diastolic non-dipping (1.85 [1.15, 2.98], P = 0.011). Similarly, men who reported EMA (19% of the cohort) had a higher odds ratio of diastolic non-dipping than those without EMA (1.57 [1.09, 2.26], P = 0.015). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+ 1.4 mmHg, P = 0.042), no other statistically significant differences in BP and heart rate were found between men with and those without insomnia symptoms. Our findings suggest that older men reporting difficulty initiating sleep or early morning awakenings may have a higher risk of nocturnal diastolic non-dipping. Our findings must be replicated in larger cohorts that also include women.

Effects of Sihogayonggolmoryeo-tang (Saikokaryukotsuboreito or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for insomnia disorder with prehypertension or stage 1 hypertension: A study protocol for a randomized controlled trial

BACKGROUND

Insomnia and hypertension are diseases with a high prevalence and a known association with each other. Sihogayonggolmoryeo-tang (SYM) is an herbal medicine traditionally used for the treatment of insomnia disorder concurrent with hypertension. However, no scientific clinical evidence exists supporting the effects of SYM on these disorders. This study aims to explore the feasibility, effectiveness, and safety of SYM for the treatment of insomnia disorder with concurrent prehypertension or stage 1 hypertension.

METHODS

A prospective, randomized, wait-list controlled, parallel, pilot clinical trial has been designed for a study to be conducted in Daejeon, Republic of Korea. Thirty insomnia disorder patients with prehypertension or stage 1 hypertension will be randomly assigned to a SYM or wait-list group at a 1:1 ratio. The SYM group will be administered SYM granules twice a day for 4 weeks and followed-up for 2 weeks while the wait-list group will not receive SYM granules. All participants in both groups will be given brochures with instructions for maintaining sleep hygiene and lifestyle modifications to reduce hypertension. Data will be collected at baseline and at 2, 4, and 6 weeks after allocation. The primary outcome is the Insomnia Severity Index score at 4 weeks post-treatment. The secondary outcomes will consist of the Pittsburgh Sleep Quality Index, sleep diary, systolic and diastolic blood pressure, brachial-ankle pulse wave velocity, ankle-brachial index, atherosclerosis biomarkers, the Hospital Anxiety and Depression Scale, the 5-level EuroQol-5 dimensions, and the Patient Global Impression of Change. Adverse events and laboratory test results will be monitored to assess the safety. Data will be recorded in electronic case report forms and analyzed using SPSS Statistics, Version 24.0.

DISCUSSION

This is the first clinical trial to explore the effectiveness and safety of SYM for the treatment of insomnia disorder concurrent with prehypertension or stage 1 hypertension. The results of this study can form the foundation for a future multicenter, large-scale, confirmatory clinical trial.

TRIAL REGISTRATION

Clinical Research Information Service, KCT0005001 (registered on May 8, 2020).

On the use of actigraphy in clinical evaluation of diurnal blood pressure profile

A disturbed diurnal blood pressure profile is one of the most important risk factors of cardiovascular diseases. This review analyzes the use of simultaneous diurnal ambulatory blood pressure monitoring (ABPM) and motion activity monitoring (actigraphy) to obtain additional information for correct interpretation of ABPM results in clinically significant decision-making. The article considers practical aspects of actigraphy in expert ABPM for clock-independent calculation of the parameters of nighttime and daytime blood pressure (BP); detection of BP changes during sleep; connection with respiratory disturbances during sleep, motion activity, and body position; and sleep deprivation in shift workers. Original illustrations of simultaneous ABPM and actigraphy are provided.

[Hypertension and insomnia]

Insomnia is frequently detected in patients with arterial hypertension (AH): from 19% to 47.9% of all cases according to epidemiological studies. On the other hand, the frequency of hypertension in patients with insomnia ranges from 21.4% to 50.2%, whereas in patients without insomnia, from 11.0% to 41.8%. In single studies in which patients with insomnia underwent ambulatory blood pressure monitoring (ABPM), these patients showed higher nocturnal blood pressure levels. Recent data suggests that insomnia is also a risk factor for hypertension. Among the pathogenetic mechanisms explaining the relationship between hypertension and insomnia, an increase in the activity of the main neuroendocrine stress systems, sympatho - adrenal and hypothalamic - pituitary - adrenal, and the frequent presence of concomitant anxiety disorders are discussed. To determine the sleep quality in patients with insomnia, the Pittsburgh Sleep Quality Index (PSQI) is most often used, patients with hypertension in a number of studies had higher total PSQI score compared to individuals with normal blood pressure. PSQI score correlates with systolic and diastolic blood pressure level, as well as with the presence of non - dipper blood pressure profile. Both hypertension and insomnia are associated with impaired cognitive functions. However, the relationship between cognitive impairment and insomnia is rather contradictory, which is most associated with the methodology for assessing cognitive functions and differences in the initial clinical and demographic characteristics of the examined patient population.

Short Sleep, Insomnia, and Cardiovascular Disease

PURPOSE OF REVIEW

This review summarizes key findings linking insomnia, short sleep duration, and cardiovascular health.

RECENT FINDINGS

Early studies associations between insomnia with short sleep and cardiovascular disease Recent studies have incorporated objective data to assess sleep and identify comorbid sleep disorders (e.g. sleep apnea). Use of objective metrics has facilitated understanding of the impacts of insufficient sleep on autonomic dysregulation, metabolic syndrome, coronary artery disease and overall cardiovascular mortality. Emerging research suggests treatment of insomnia (CBT-I) may be beneficial in terms of reducing cardiovascular disease risk.

SUMMARY

From short term effects on the autonomic nervous system to lasting effects on metabolic syndrome and coronary artery disease, there is growing evidence to support a physiologic pathway by which insomnia with short sleep contributes to cardiovascular disease. More research is needed to understand the effect of insomnia treatment on cardiovascular risk.

Sleep and cardiovascular disease: Emerging opportunities for psychology

Sleep disturbances and disorders have been implicated in cardiovascular morbidity and mortality. Converging evidence suggests that psychosocial factors that confer risk or resilience to cardiovascular disease (CVD) are also related to sleep. Profound differences in sleep among racial/ethnic minorities compared with non-Hispanic Whites in the United States suggest that sleep, and its interplay with psychosocial factors, may contribute to observed disparities in CVD and in health and functioning more broadly. Less understood is the extent to which sleep and psychosocial factors interact to influence the pathophysiology and clinical course of CVD. This article reviews observational and experimental evidence linking short sleep duration and insomnia, both modifiable sleep disturbances, to CVD, including key physiological mechanisms. Also reviewed is evidence of significant interrelationships among sleep, race/ethnicity, and psychosocial factors known to confer risk or resilience to CVD, including depression, psychological stress, and close interpersonal relationships. It is proposed that a transdisciplinary research framework that integrates knowledge, methods, and measures from the fields of psychology and sleep research may be used to catalyze advances in the prevention and treatment of CVD. Also discussed are promising new directions, expected challenges, and the importance of training in transdisciplinary science and research approaches. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Restless legs syndrome, periodic limb movements during sleep and cardiovascular risk

Multiple mechanisms may modulate an association between restless legs syndrome/Willis-Ekbom disease (RLS/WED) and cardiovascular disease (CVD), including chronic sleep deprivation, intermittent, periodic limb movements in sleep (PLMS)-related autonomic fluctuations and possible autonomic dysfunction intrinsically associated with RLS per se. The purpose of this paper is to review the existing RLS/WED literature focusing on the pathophysiologic evidence for possible associations between RLS/WED and PLMS with CVD and events (CVE). Specific intrinsic dysautonomic aspects of the disease, which may contribute to generating CVD, are separately discussed. The association between RLS/WED and both CV risk factors and CVD still remains elusive. Although several shared pathophysiological causes could explain these possible relationships, the emerging body of literature focusing on these disorders remains controversial. Not only longitudinal population-based studies and meta-analyses, but also more animal models and therapeutic interventions are needed in order to build a sufficiently robust body of evidence on this topic.