Association of novel measures of sleep disturbances with blood pressure: The Multi-Ethnic Study of Atherosclerosis

John S. Kim*, Ali Azarbarzin, Rui Wang, Ina E. Djonlagic, Naresh M. Punjabi, Phyllis C. Zee, Brian B. Koo, Elsayed Z. Soliman, Magdy Younes, Susan Redline

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background Mechanisms underlying blood pressure (BP) changes in obstructive sleep apnoea (OSA) are incompletely understood. We assessed the associations between BP and selected polysomnography (PSG) traits: sleep depth, airflow limitation measurements and OSA-specific hypoxic burden. Methods This cross-sectional analysis included 2055 participants from the Multi-Ethnic Study of Atherosclerosis who underwent PSG and BP measurements in 2010-2013. Sleep depth was assessed using the â € OR product', a continuous measure of arousability. Airflow limitation was assessed by duty cycle (T i /T t) and % of breaths with flow limitation, and hypoxia by â € hypoxic burden'. Primary outcomes were medication-adjusted systolic BP (SBP) and diastolic BP (DBP). We used generalised linear models adjusted for age, sex, race/ethnicity, smoking, education, body mass index, alcohol use, periodic limb movements and alternative physiological disturbances. Results The sample had a mean age of 68.4 years and apnoea-hypopnoea index of 14.8 events/hour. Sleep depth was not significantly associated with BP. Every 1 SD increment in log-transformed non-rapid eye movement duty cycle was associated with 0.9% decrease in SBP (95% CI: 0.1% to 1.6%), even after adjusting for sleep depth and hypoxic burden. Every 1 SD increment in log-transformed hypoxic burden was associated with a 1.1% increase in SBP (95% CI: 0.1% to 2.1%) and 1.9% increase in DBP (95% CI: 1.0% to 2.8%) among those not using hypertension medications. Conclusions Higher duty cycle was associated with lower SBP overall and hypoxic burden with higher SBP and DBP among non-BP medication users. These findings suggest changes in both respiratory effort and oxygenation during sleep influence BP.

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalThorax
Volume75
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • duty cycle
  • hypertension
  • hypoxia
  • inspiratory flow limitation
  • sleep apnoea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Kim, J. S., Azarbarzin, A., Wang, R., Djonlagic, I. E., Punjabi, N. M., Zee, P. C., Koo, B. B., Soliman, E. Z., Younes, M., & Redline, S. (2020). Association of novel measures of sleep disturbances with blood pressure: The Multi-Ethnic Study of Atherosclerosis. Thorax, 75(1), 57-63. https://doi.org/10.1136/thoraxjnl-2019-213533