May 5, 2023Open Access

Ambulatory Blood Pressure Monitoring and Sleep Quality in Hypertensive Men and Women

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Untreated hypertension (n=50). Intervention: 24-hour ambulatory blood pressure monitoring (ABPM) vs. Non-ABPM days. Primary outcome: Sleep efficiency and total sleep time.

Key Result

Ambulatory blood pressure monitoring had no negative effects on total sleep time or sleep efficiency compared to non-monitoring days in patients with untreated hypertension.

Study Design

Type

Observational (n=50)

Multicenter

Structured PICO

Does 24-h ambulatory blood pressure monitoring reduce sleep quality in adults with untreated hypertension?

Population

50 adults (25 men, 25 women) aged 30-50 years with untreated Stage 1 and 2 hypertension (2017 ACC criteria). Exclusions included BMI >35 kg/m2, pacemaker, atrial fibrillation, obstructive sleep apnea, myocardial infarction, surgery within 6 months, heart failure, and diabetes mellitus.

Intervention

24-hour ambulatory blood pressure monitoring (ABPM) for 3 days

Comparator

7 working non-ABPM days (baseline)

Outcome

Sleep quality assessed objectively by wrist actigraphy (sleep efficiency and total sleep time) and subjectively by the Pittsburgh Sleep Quality Index (PSQI)patient reported

24-hour ambulatory blood pressure monitoring does not negatively impact objective sleep quality in patients with untreated hypertension, though poor sleep quality is common in this population.

Limitations

Use of wrist actigraphy instead of the gold standard polysomnography to assess sleep quality
Small sample size may have caused minor effects to be missed
Timing of the 24-h ABPM sessions were separated by 7 days rather than in a continuous 72-h period

Abstract

Objectives: This study aims to provide major insight in 24-h ambulatory blood pressure monitoring (ABPM), which will describe the 24 h (Circadian rhythm) blood pressure (BP) profile by measuring its impact on the sleep quality. Materials and Methods: For the study, 25 men and 25 women were recruited. Sleep quality was assessed by the Pittsburgh Sleep Index. Using wrist actigraphy, sleep-quality was assessed during seven working non-ABPM days (starting point) and the three following 24-h ABPM days. Results: During the day, the average AMP was 139.2 10.9/83.4 8.6 mm Hg, while at night, it was 118.9 12.9/68.5 9.7 mm Hg. There were 40 dipper and 10 non-dipper, respectively, on the standard of a systolic BP dip of <10%. Time had no bearing on total sleep time or sleep efficiency between ABPM days and non-ABPM days, indicating that ABPM has no negative effects on sleep quality. Conclusion: Both male and female having untreated hypertension were found to have disrupted sleep quality. Importantly, it is now evident that the ABPM has a negative impact on sleep quality for either dippers or non-dippers.

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