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

1 Citation (Scopus)

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

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Atherosclerosis
Sleep
Blood Pressure
Polysomnography
Obstructive Sleep Apnea
Apnea
Eye Movements
Linear Models
Body Mass Index
Extremities
Cross-Sectional Studies
Smoking
Alcohols
Hypertension
Education
Pressure

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Kim, John S. ; Azarbarzin, Ali ; Wang, Rui ; Djonlagic, Ina E. ; Punjabi, Naresh M. ; Zee, Phyllis C. ; Koo, Brian B. ; Soliman, Elsayed Z. ; Younes, Magdy ; Redline, Susan. / Association of novel measures of sleep disturbances with blood pressure : The Multi-Ethnic Study of Atherosclerosis. In: Thorax. 2020 ; Vol. 75, No. 1. pp. 57-63.
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title = "Association of novel measures of sleep disturbances with blood pressure: The Multi-Ethnic Study of Atherosclerosis",
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 {\^a} € 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 {\^a} € 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.",
keywords = "duty cycle, hypertension, hypoxia, inspiratory flow limitation, sleep apnoea",
author = "Kim, {John S.} and Ali Azarbarzin and Rui Wang and Djonlagic, {Ina E.} and Punjabi, {Naresh M.} and Zee, {Phyllis C.} and Koo, {Brian B.} and Soliman, {Elsayed Z.} and Magdy Younes and Susan Redline",
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Kim, JS, Azarbarzin, A, Wang, R, Djonlagic, IE, Punjabi, NM, Zee, PC, Koo, BB, Soliman, EZ, Younes, M & Redline, S 2020, 'Association of novel measures of sleep disturbances with blood pressure: The Multi-Ethnic Study of Atherosclerosis', Thorax, vol. 75, no. 1, pp. 57-63. https://doi.org/10.1136/thoraxjnl-2019-213533

Association of novel measures of sleep disturbances with blood pressure : The Multi-Ethnic Study of Atherosclerosis. / Kim, John S.; Azarbarzin, Ali; Wang, Rui; Djonlagic, Ina E.; Punjabi, Naresh M.; Zee, Phyllis C.; Koo, Brian B.; Soliman, Elsayed Z.; Younes, Magdy; Redline, Susan.

In: Thorax, Vol. 75, No. 1, 01.01.2020, p. 57-63.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of novel measures of sleep disturbances with blood pressure

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Kim, John S.

AU - Azarbarzin, Ali

AU - Wang, Rui

AU - Djonlagic, Ina E.

AU - Punjabi, Naresh M.

AU - Zee, Phyllis C.

AU - Koo, Brian B.

AU - Soliman, Elsayed Z.

AU - Younes, Magdy

AU - Redline, Susan

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

KW - duty cycle

KW - hypertension

KW - hypoxia

KW - inspiratory flow limitation

KW - sleep apnoea

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U2 - 10.1136/thoraxjnl-2019-213533

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