Study Of Sleep Quality Hypertension And Blood Pressure Rhythm Correlation

BACKGROUND:Nowadays, With the emerging and development of sleep medicine, sleep is no longer just defined as the rehabilitation and recuperation mentally and physically, the part of sleep disorders playing in a variety of chronic disease has been gradually revealed, and getting more and more attention. Epidemiological studies and clinical observations have confirmed that the incidence of sleep disorders in hypertensive crowd was significantly increased, the incidence of hypertensive patients combining insomnia was40%, and the longer time this disease lasts, the more patients get sleep disorder. Sleep can affect blood pressure by changing the function of autonomic nervous system and other physiological factors, insomnia can lead to a higher blood pressure. And in turn, this elevated blood pressure can also affect sleep by neurohormonal regulation pathways, ect. Hypertension and sleep problems in these patients can affect each other in the same way. Therefore, it is quite necessary to make some intervention to cutting this sleep problems-higher blood pressure interaction in preventing the progress of hypertension. So, this requires clinicians fully acquiring the sleep knowledge of hypertensive patients, assessing the main problems during their sleep. For patients with both hypertension and insomnia, controlling blood pressure is inseparable from the treatment of insomnia. Improvement of insomnia plays an important role in treating and preventing hypertension and all the complications from becoming worse.The doctors from the ancient China recognized that all the human internal activities followed the way as nature goes. In order to survive from natural selection, people must constantly adapt to cyclical changes in nature by following nature laws consistently. Otherwise people would be trapped by disease which brought by breaking their own biorhythm.OBJECTIVE: By retrospectively analyzing all the results of ambulatory blood pressure monitoring and sleeping monitoring gathering from patients, our aim was to explore the sleep quality、the circadian rhythm of blood pressure、and the interaction of this circadian rhythm and the sleep quality, and summarize sleep structures by analyzing them based on ancient China time-dividing method. We doctors should guide patients to follow a healthy lifestyle, and we are going to find certain theoretical basis to get new ways to make controlling the blood pressure an easy thing to do.METHODS:By giving synchronously ambulatory blood pressure monitoring and sleeping monitoring to the patients taken into in the International Medical Department of China-Japan Friendship Hospital from2013/09to2014/03, we collected the patient’s medical history, the Pittsburgh Sleep Quality Index score, the results of ambulatory blood pressure monitoring, the results of CPC sleep monitoring (including an overall assessment of the sleep quality and sleep structure based on ancient China time-dividing method), etc. Results were contrasted and analyzed according to the hypertension and the control group. Thus we separated the patients into different groups by considering their ABPM result (different blood pressure types) and CPC-AHI scores (normal-mild and moderate-severe OSAS groups), then did the analysis as the groups we set. Statistical methods using the chi-square test count data, independent samples t-test, measuring data between multiple groups we used the variance test.RESULTS:This clinical study showed that,①hypertensive patients have a prolonged time entering sleep, increased light sleep, and reduced deep sleep characteristics, some results are statistically significant different(P<0.05).There is a large number hypertensive patients in moderate-evere OSAS, hypertensive patients who combines a moderate-severe OSAS have a lower mean deep sleep proportion and a higher light sleep proportion.②From circadian blood pressure fluctuations, the average daytime SBP and DBP and good overall hypertensive group, but the night situation was poorly controlled; dipper group can fall asleep in shortest time, and has the highest mean deep sleep proportion and the least light sleep proportion, least dream/wake percentage (P<0.05).③After taking CPC-AHI into consideration, we could see that the reverse-dippers combing moderate-severe OSAS have the least mean deep sleep proportion and the highest light sleep proportion.④In this study we could see that the control group has more deep sleep proportion in HaiShi and ChouShi; dipper group has the highest proportion of deep sleep (P<0.01) in ChouShi. From the perspective of the overall trend, normal-mild OSAS group has more light sleeping proportion of each hour(based on ancient China time-dividing method), and moderate-severe OSAS group has more light sleep proportion of each hour, and moderate-severe OSAS group in each hour of sleep snores more often, this results were significantly different(P<0.05,P<0.01).CONCLUSION:The sleep quality in hypertension patients is significantly worse, mainly as follows:difficulty falling asleep, reducing deep sleep and increasing light sleep; in hypertensive patients, the number of people combining with sleep apnea was significantly high; hypertensive patients who combines a moderate-severe OSAS have a lowest mean deep sleep proportion and a highest light sleep proportion. The presence of high blood pressure in patients are easily getting abnormal blood pressure rhythm; reverse-dippers combing moderate-severe OSAS have the lower mean deep sleep proportion and the higher light sleep proportion. The normal circadian rhythm of blood pressure--dipper group has a good quality of sleep: easily falling into sleep, the highest proportion of deep sleep, the lowest light sleep proportion, and the lowest dream/wake percentage. Based on ancient China time-dividing method analyzing sleep architecture, a conclusion we could draw here:ChouShi is the very essential period in everyday’s rest.