Relationship Between Sleep Quality And Target Organ Damage In Patients With Hypertension

Objective:To analyze the effects of sleep quality on ambulatory blood pressure(ABBP),target organ and metabolism in middle-aged and older patients with hypertension.Methods:From July 2017 to March 2018,the middle-aged and older patients who were hospitalized in the department of cardiovascular medicine and cadre ward of the first affiliated Hospital of Fujian Medical University were selected as the study subjects.The Chinese version of Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep quality.All subjects were examined with echocardiography,and some of them completed ABBP monitoring.And sex,height,weight,fasting blood glucose,uric acid,urea nitrogen,serum creatinine,glomerular filtration rate,blood lipids,and urine microalbumin.,urinary albumin / urinary creatinine ratio,cortisol,adrenocorticotropic hormone and other clinical indicators were collected from each group.The effects of sleep quality on ABBP,target organs and metabolism,and the correlation between ABBP and left ventricular mass index(LVMI)were studied by independent sample t-test and Spearman correlation analysis.Results:223 patients were selected and the average age of the subjects was 62.49 ±9.36 years old.There were 109 males and 114 females.119 patients with total score of PSQI > 7 were included in the group of sleep disorders,and 104 patients with total score of PSQI ? 7 were included in the group without sleep disorder.(1)Blood pressure in sleep disorder group compared with non-sleep disorder group:(1)the average systolic pressure increased significantly(P <0.05)throughout the day,day and night;(2)The mean pulse pressure increased significantly during the whole day and day P <0.05);(3)The systolic pressure load increased significantly in all day,day and night(P <0.05);(4)Morning blood pressure surge(MBPS)in sleep disorder group was significantly higher than that of the sleep disorder group(P <0.05);(5)Early morning systolic blood pressure was increased(P < 0.05).(2)Compared with the results of non-sleep disorder group,metabolic and target organ damage:(1)TC,LDL,AI and LVMI were significantly higher than those without sleep disturbance(P <0.05);(2)There was a significant increase of cortisol at 8:00 and 16:00 with a statistically significant result(P <0.05).(3)Factors related to left ventricular mass index:(1)The left ventricular mass index positively correlated with all-day,daytime and nighttime systolic pressure and daytime diastolic pressure(P <0.05);(2)was positively correlated with mean pulse pressure all day,daytime and nighttime(P <0.05),and positively correlated with all-day,daytime and night systolic pressure load(P <0.05);(3)was positively correlated with morning blood pressure(P <0.05),and was an independent risk factor of left ventricular hypertrophy(? = 0.007,adjustment r2= 0.226,P = 0.013 <0.05);(4)was positively correlated with PSQI score(P <0.05).(4)In the group of poor subjective sleep quality,compared with the group with better subjective sleep quality:(1)the average pulse pressure and the average pulse pressure index increased significantly during the whole day(P < 0.05);(2)MBPS was significantly increased(P < 0.05).Conclusion:Among the middle-aged and older hypertensive patients,sleep disorders are associated with ABBP,blood lipids and cortisol.Sleep disorders also affect LVMI,but are not independent risk factors.