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Blood pressure levels and sleep characteristics: preliminary results of ambulatory blood pressure monitoring in a subsample of ELSA-Brasil
Daily blood pressure (BP) regulation is associated with pathophysiological alterations that occur during the sleep-wake cycle, suggesting that BP is particularly sensitive to sleep changes. However, the influence of sleep alterations on blood pressure levels, such as nocturnal dipping, BP variability, and morning surge, which are important predictors of cardiovascular risk, is unclear.
To describe nocturnal dipping patterns (dipping, reduced/reverse dipping, extreme dipping) according to sleep duration and insomnia symptoms, BP levels (variability and morning surge), and sociodemographic factors in a sample of public servants.
A descriptive study including 850 participants from the second wave of ELSA-Brasil whose BP was monitored for 24 hours using a Spacelabs 90207 device, programmed to perform measurements every 20 minutes during awake time and every 30 minutes during sleep. Nocturnal dipping was calculated by the difference between mean waking and sleeping BP. Variability was evaluated from the standard deviation of the mean and morning surge by means of the sleep-through morning surge classification. Self-reported sleep duration, insomnia symptoms, as well as sociodemographic data and lifestyle habits were also evaluated. R software, version 3.5.2 was used for the analysis.
The mean age was 52±9.1 years, with 50% men. The group classified with reduced/reverse dipping (32%) had a higher frequency of men (57%), black/brown color/ethnicity (48%), overweight and obesity (71%), and greater nocturnal BP variability compared to the groups dipping and extreme dipping. The prevalence of hypertension was higher among reduced/reverse dippers (48%) compared to dipping (39%) and extreme dipping patterns (36%). Morning surge was lower among reduced/reverse dippers, however, the elevation measures varied more in this group. Among individuals with reduced/reverse dipping, 54% reported short sleep duration and 23% reported insomnia symptoms, similar to those with pattern dipping.
Participants classified with reduced/reverse nocturnal dipping presented a higher prevalence of hypertension and higher blood pressure variability than those with dipping or extreme dipping pattern. However, no differences were observed regarding alterations in sleep. Further analysis will contribute to our understanding of which sleep factors are associated with nocturnal dipping. Findings may support important public health policies.
sleep, blood pressure, ambulatory blood pressure monitoring
ISABELA ANDRELINO ALMEIDA, DANIELA POLESSA PAULA, LEIDJAIRA LOPES JUVANHOL, JOSÉ G MILL, ENIRTES CAETANO PRATES MELO, MARIA DE JESUS MENDES DA FONSECA, ALINE SILVA-COSTA, ROSANE HARTER GRIEP