Influence Of Subjective, Objective Sleep Quality And Related Factors In Elderly Hypertension Patients On Blood Pressure

Objection:1,Research the difference between the hypertension patients with primary insomnia and the ones without the disease under taking antihypertensive medicine regularly.2.Research the difference between hypertension patients with primary insomnia and the ones without this disease on subjective sleep perception and objective determination, and to explore the effect of sleep consciousness characteristics on blood pressure.3.Research the difference between hypertension patients with primary insomnia and the ones without this disease on emotion, and observe the relevance of sleep quality and emotion.4.Research the difference between hypertension patients with primary insomnia and the ones without this disease on blood biochemical parameters, and observe the relevance of sleep quality index and blood biochemical parameters.METHODS:According to "Chinese Hypertension Prevention Guide"(2010edition) and the International Classification of sleep disorders(ICSD) diagnostic criteria, selecting54hypertension patients from March2013to March2014, between the ages of45-89, collecting their basic information, including names, gender, ages, contact information, height, weight, abdominal circumference, education, race, occupation, medical histories, family histories and drug histories. Define the hypertension patients with primary insomnia as experimental group, and exists29cases. Define the ones without primary insomnia as control group, and exists25cases. Use Pittsburgh Sleep Quality Index (PSQI), bedtime questionnaires to assess subjective sleep quality. Use PSG examination to assess objective sleep quality. Then through "subjective total sleep time/objective total sleep time*100%" to compute sleep perception. Use Hamilton anxiety Scale(HAMA) and Hamilton depression Scale(HAMD) to assess the emotional state. After PSG examination, the patients will have fasting blood tests, including blood glucose(FPG), total cholesterol(TC), triglyceride(TG), high density lipoprotein(HDL-C), low density lipoprotein protein(LDL-C), urea nitrogen(BUN), creatinine(Scr) and uric acid(UA).RESULTS:1.In the experimental group, the DBP at8:00and20:00(P<0.05) are higher, while the SBP at the two time have no difference(P>0.05).2.In terms of subjective sleep quality, the sleep latency (P<0.05) is longer, the total sleep time(P<0.05) is shorter, PSQI scores(P<0.05) is higher, sleep efficiency(P<0.05) is poorer in the experimental group. In terms of objective sleep quality, the sleep latency (P＜0.05) is longer, the total sleep time(P<0.05), N3duration(P<0.05), N3proportion(P<0.05) is shorter, sleep efficiency(P<0.05) is lower, arousal index(P<0.05) is higher, wake time(P<0.05) is longer and sleep perception (P<0.05) is lower in the experimental group. While there is no difference on N1duration(P>0.05), N1proportion(P>0.05), N2duration(P>0.05), N2proportion(P>0.05), REM duration(P>0.05), REM proportion(P>0.05). The subjective total sleep time of experimental group is shorter than the control group [(289.29±44.13)]、[(347.66±81.73)min].3. In linear regression results shows that:①PSQI scores have a positive correlation with8:00and20:00SBP. It means the poorer subjective sleep quality is, the higher the SBP is. And there is no correlation between PSQI scores and DBP.②There is no correlation between sleep perception, subjective sleep latency, the subjective total sleep time, objective sleep latency, the objective total sleep time and SBP,DBP. 4.Both groups in the case of no anxiety or depression drugs, the HAMA and the HAMD scores (P<0.05) of experimental group is both higher than control group, and the patients have more obvious anxiety and depression.5.①Sleep perception and HAMA, HAMD scores are negatively correlated. It means that the higher the perception of sleep, the less anxiety and depression occurs.②Subjective sleep latency and HAMA,HAMD scores are positively correlated. It means that the longer subjective sleep latency, the more severe to be anxiety and depressive.③Subjective total sleep time and HAMA, HAMD scores are negatively correlated. It means that the longer the sleep time is, the less anxiety and depression occurs.④There is no correlation between objective sleep latency, total sleep time and HAMA,HAMD scores.6.HAMA, HAMD scores and subjective sleep time, subjective sleep efficiency, sleep perceived are negatively correlated. It means that when anxiety and depression perform significantly, the total time is reduced and the subjective sleep efficiency decreased and the sleep perception reduced. HAMA, HAMD scores and subjective sleep latency are positively correlated. It means that when anxiety and depression perform significantly, the subjective sleep latency increased. And HAMA, HAMD scores have no correlation with objective total sleep time, objective sleep latency, objective sleep efficiency.7.In experimental group, FPG(P<0.05) and UA(P<0.05) is higher. While TC(P>0.05), TG(P>0.05), HDL-C(P>0.05), LDL-C(P>0.05), BUN(P>0.05) and Scr(P>0.05) have no significant difference between the two groups.8.PSQI scores and FPG, UA are positively correlated, that means the higher PSQI scores are, the higher FPG and UA is. PSQI scores,subjective sleep latency, total sleep time, objective sleep latency, sleep perception and arousal index have no correlation with other blood biochemical parameters.9. After PSG examination, there are6cases of patients in the experimental group diagnose with sleep apnea syndrome(OSAHS), accounting for20.69%; the control group has5cases, accounting for20%. CONCLUSION:1.Hypertension patients with primary insomnia has a poor blood pressure control.2.Hypertension patients with primary insomnia perform subjective and objective sleep quality declined, total sleep time decreased, sleep latency increased, sleep efficiency decreased and sleep perception decreased. The poorer subjective sleep quality is, the more difficult to control the blood preesure. Prompt us to increase the observation on the sleep quality of hypertension patients during clinic treatment.3.Hypertension patients with primary insomnia always accompany significant anxiety and depression. When the subjective total sleep time decreased, subjective sleep efficiency decreased, sleep perception decreased, they will perform more significant anxiety and depression. While there is no correlation between objective index with anxiety and depression. Meanwhile, when anxiety and depression perform significant, the patients’subjective total sleep time, sleep efficiency will be shorter, subjective sleep efficiency will decrease, sleep consciousness will decrease, subjective sleep latency will be longer, while there is no correlation between anxiety, depression and objective sleep index. Anxiety and depression assess affects blood pressure control in hypertension patients.4.FPG and UA levels in hypertension patients with primary insomnia is higher than the patients without primary insomnia. While there is no difference between the two kind of patients on TC, TG, HDL-C, LDL-C, BUN and Scr.5.Complained of hypertension patients with sleep disorders, denying snoring, nighttime arousal, having a history of respiratory disease and lower respiratory tract stenosis, can have sleep apnea syndrome.