Short sleep time a modifiable risk factor for prehypertension and … · 2018. 2. 25. · ©AP...
Transcript of Short sleep time a modifiable risk factor for prehypertension and … · 2018. 2. 25. · ©AP...
©AP
Short sleep time – a modifiable risk factor for prehypertension and hypertension
Aleksander PrejbiszDepartment of Hypertension
Institute of Cardiology
Warsaw, Poland
Venice, 23rd February 2018
©AP
©APCirculation, November 2011
©AP
Normal hypnogram
W
1
REM
2
3
4
0 1 2 3 4 5 6 7 8 heures
©AP
W
1
REM
2
3
4
0 1 2 3 4 5 6 7 8 heures
Sleep fragmentation
quality of sleep
©AP
W
1
REM
2
3
4
0 1 2 3 4 5 6 7 8 heures
Shortening of the sleep time
sleep time
©AP
SLEEP
DISORDERS
Consequences of Sleep Disruption. Muncey, Aaron R., MD, Murray and Nadel's Textbook of Respiratory Medicine, 87, 1547-1551.e
sleep quality sleep quantity
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
©AP
Sleep timeIntermittent hypoxia
Sleep apnea Short sleep time Insomnia
after Pepin JL i wsp. 2010 modified
Sleep disorders and hypertension
Microarousals↓ sleep quality
Sympathetic activity
Endothelial dysfunction
Inflammation Oxidative
stressAcute
symp. surges
Night-time hypertension
Daytime hypertension
©AP
AHI 113 / h
T< 90% - 57,3%
min SaO2 – 46%, śr SaO2 – 85%
Polysomnography – obstructive sleep apnea
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
©AP
Insomnia – subjective patent’s feeling that
that the quality of sleep is inadequate
or that the sleep is not refreshing
Insomnia is associated with negative impact on daytime activities
(Zorick, 1989)
„O sleep, O gentle sleep,Nature's soft nurse, how have I frighted thee,That thou no more wilt weigh my eyelids downAnd steep my sense in forgetfulness?”William ShakespeareHenry IV, Part I
Insomnia
©AP
▪ Population sample – 1206 subjects
▪ Athens Insomnia Scale
▪ Frequency of insomnia: 30.7 %
Frequency of insomnia – population of one Warsaw’s district
POL-MONICA BIS 2001
Piwoński J et al. 2003
©AP
-20
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
Systolic BP Diastolic BP
%
With insomnia Bez bezsenności
P<0,01
P<0,01
Prejbisz A, Kabat M, Januszewicz A et al. Blood Pressure 2006
Untreated hypertensive subjects – night-time blood pressure decline
– patients with insomnia vs those without insomnia
©AP
Anxiety
disorders
Primary
insomnia
INSOMNIA
Depression
Chronic
somatic
diseases
Secondary
©APVgontzas AN et al. Sleep 2009
Insomnia with objective short sleep durationis associated with a high risk for hypertension
©APGangwisch JE et al. Am J Hypertens 2009
Insomnia and sleep durationas mediators of relationship between depressionand hypertension incidence
©APLa Y et al. Hypertension. 2015;65:644-650
Insomnia with physiological hyperarousalis associated with hypertension
©APNadciśnienie Tętnicze 2014, tom 18, nr 4, strony: 182–193
YES
YES
NO
NO
Insomnia
Hypertension
Wak
e t
ime
aft
er
sle
ep
on
set
(%)
Relationship between insomnia and sleep quality and structure in patients with hypertension
©AP
Sofietal.EurJPrevCardiol.2014Jan;21(1):57-64
13studies122501subjectfreeofCVDFollow-up3-20years
©APAmerican Journal of Hypertension 30(3) March 2017 319
Sleep to Lower Elevated Blood Pressure: A Randomized Controlled Trial (SLEPT)
web-delivered sleep intervention (sleep–hygiene education, stimulus control, and cognitive behavioral therapy)8 weeks follow-up
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
©AP
0
1
2
3
4
5
6
7
8
9
1910 1975 2005
9
7.56.8
SLEE
P D
UR
ATI
ON
(H
)
National Sleep Fundation. Sleep in America Poll "05
Mean sleep duration- USA 1910 2005
-2h
©APCirculation 2008
Obniżonym wskaźnikem skuteczności snu
Adolescents – age 13 – 16 years (n=238)Relationship between prehypertension and:
Krótkim czasem snu (≤6,5h)
Low sleep efficiency
Short sleep time (≤6,5h)
Sleep quality and elevated BP in adoescents
©AP
Relationship between short sleep time and HT – meta-analysis
Sleep Medicine 14 (2013) 324–332
Epidemiological evidence for the link between sleep duration and high BP
©APJ Am Heart Assoc. 2017;6:e005947. DOI: 10.1161/JAHA.117.005947
Sleep duration – relation with CVD morbidity and mortality- meta-analysis – 57 studies
7 hours 7 hours
©APFernandez-Mendoza J i wsp. Journal of Hypertension 2017
Sleep duration modifiesthe relationship between HT and mortality
©APSchmid, Sebastian M, MD, Lancet Diabetes & Endocrinology, The, Volume 3, Issue 1, 52-62
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
POL-FOKUS study
©AP
Pol-Fokus Study
Sleep disorders in hypertensive subjects
ESH 2017
High risk of OSA
• STOP-Bang questionnaire
Insomnia
• Athens Insomnia Scale ≥8 points
Short sleep duration
• Mean <6 hours – last 6 months
©AP
Pol-Fokus Study
Prevalence of sleep disorders in patients with resistant HT
ESH 2017
31.1%
43.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
RHT (-) RHT (+)
OSA
32.7%
41.2%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
RHT (-) RHT (+)
INSOMNIA
11.3%
17.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
RHT (-) RHT (+)
SHORT SLEEP TIME
©AP
Pol-Fokus Study
Factors related with resistant HT
ESH 2017
High risk of OSA 1.38
Insomnia 1.32
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
©AP
Shift-work and risk of HT
2010, 2013
©APJ Hypertens 2005; 23:2173-2178
Progression of hypertension- relation to shift-work
6495 men with mild HT – steel factoryFollow-up 1991 - 2001
©APJ Hypertens 2017; 35:1929-1937
Relationship between shift-workand nighttime work and HT
Cohort studies
Shfit-work > Nighttime work
Cross-sectional studies
©APAJ©AP
Short sleep time– a modifiable riskfactor forprehypertensionand hypertension
Obstructive sleep apnea
Insomnia
Short sleep time
Shift-work
medice, cura te ipsum ……
©APN Engl J Med 2004;351:1829-37.
85h/week 65h/week
Eliminating interns’ extended work shifts increasedsleep and decreased attentional failures during night work hours
©APN Engl J Med 2004;351:1829-37.
Eliminating interns’ extended work shifts increasedsleep and decreased attentional failures during night work hours
Sleep duration and work durationSleep duration
„Attentional Failures”
©APEuropean Heart Journal (2009) 30, 2606–2613
Arrhytmias- frequency during night-time shifts
0,5 vs 0,0
©AP
High risk of near-crash driving events followingnight-shift work
Lee i wsp. PNAS 2016
Postsleep drive
Postnight-shift drive
Postsleep drive
Postnight-shift drive
Postsleep drive
Postnight-shift drive
©AP
Der Bach singt voller Wohllaut durch das Dunkel.Die Blumen blassen im Dämmerschein.Die Erde atmet voll von Ruh' und Schlaf.Alle Sehnsucht will nun träumen,Die müden Menschen geh'n heimwärts,Um im Schlaf vergess'nes GlückUnd Jugend neu zu lernen!Die Vögel hocken still in ihren Zweigen.Die Welt schläft ein