Subjective sleep quality, blood pressure, and hypertension: a meta-analysis.
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ABSTRACT:
SUBMITTER: Lo K
PROVIDER: S-EPMC8031314 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background and objectivesSleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in patients with migraine. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep architecture measured using polysomnography (PSG) between adult and pediatric patients and healthy controls.MethodsThis review was preregistered on PROSPERO (CRD42020209325). A systematic search of 5 databases (Embase, MEDLINE, Global Health, APA PsycINFO, and APA PsycArticles, last searched on December 17, 2020) was conducted to find case-control studies that measured PSG or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale and publication bias with the Egger regression test.ResultsThirty-two studies were eligible, of which 21 measured PSQI or Migraine Disability Assessment Test in adults, 6 measured PSG in adults, and 5 measured PSG in children. The overall mean study quality score was 5/9; this did not moderate any of the results and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g = 0.75, p < 0.001, 95% confidence interval [CI] 0.54-0.96). This effect was larger in those with a chronic rather than episodic condition (g = 1.03, p < 0.001, 95% CI 0.37-1.01; g = 0.63, p < 0.001, 95% CI 0.38-0.88, respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of rapid eye movement sleep (g = -0.22, p = 0.017, 95% CI -0.41 to -0.04; g = -0.71, p = 0.025, 95% CI -1.34 to -0.10, respectively) than controls. Pediatric patients displayed less total sleep time (g = -1.37, p = 0.039, 95% CI -2.66 to -0.10), more wake (g = 0.52, p < 0.001, 95% CI 0.08-0.79), and shorter sleep onset latency (g = -0.37, p < 0.001, 95% CI -0.54 to -0.21) than controls.DiscussionPeople with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.
| S-EPMC8548957 | biostudies-literature
Project description:To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21?mmHg [95% confidence interval (CI): -9.04 to -5.38; P?<?0.001; I² 58%) and -4.99?mmHg (95% CI: -6.01 to -3.96; P?<?0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74?mmHg [95% CI: -9.98 to -3.49; P?<?0.001; I² 61%] and -5.94?mmHg (95% CI: -9.40 to -2.47; P?=?0.001; I² 76%), respectively, in favor of the CPAP group.The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
| S-EPMC4291165 | biostudies-literature
Project description:We assessed whether insufficient sleep is associated with prehypertension in healthy adolescents.We undertook a cross-sectional analysis of 238 adolescents, all without sleep apnea or severe comorbidities. Participants underwent multiple-day wrist actigraphy at home to provide objective estimates of sleep patterns. In a clinical research facility, overnight polysomnography, anthropometry, and 9 blood pressure measurements over 2 days were made. Exposures were actigraphy-defined low weekday sleep efficiency, an objective measure of sleep quality (low sleep efficiency < or =85%), and short sleep duration (< or =6.5 hours). The main outcome was prehypertension (> or =90th percentile for age, sex, and height), with systolic and diastolic blood pressures as continuous measures as secondary outcomes. Prehypertension, low sleep efficiency, and short sleep duration occurred in 14%, 26%, and 11% of the sample, respectively. In unadjusted analyses, the odds of prehypertension increased 4.5-fold (95% CI, 2.1 to 9.7) in adolescents with low sleep efficiency and 2.8-fold (95% CI, 1.1 to 7.3) in those with short sleep. In analyses adjusted for sex, body mass index percentile, and socioeconomic status, the odds of prehypertension increased 3.5-fold (95% CI, 1.5. 8.0) for low sleep efficiency and 2.5-fold (95% CI, 0.9 to 6.9) for short sleep. Adjusted analyses showed that adolescents with low sleep efficiency had on average a 4.0+/-1.2-mm Hg higher systolic blood pressure than other children (P<0.01).Poor sleep quality is associated with prehypertension in healthy adolescents. Associations are not explained by socioeconomic status, obesity, sleep apnea, or known comorbidities, suggesting that inadequate sleep quality is associated with elevated blood pressure.
| S-EPMC2798149 | biostudies-literature
Project description:AimsNondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample.MethodsA subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately.ResultsIn cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3-3.5) for 1-h longer waking after sleep onset, 2.1 (1.1-5.1) for 7-8 h total sleep time, and 3.7 (1.3-10.7) for at least 8-h total sleep time (compared with total sleep time 6-7 h), and 1.9 (1.1-3.4) for sleep efficiency less than 0.8, respectively.ConclusionClinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.
| S-EPMC7882242 | biostudies-literature
Project description:Genome-wide association studies (GWAS) have uncovered numerous genetic variants (SNPs) that are associated with blood pressure (BP). Genetic variants may lead to BP changes by acting on intermediate molecular phenotypes such as coded protein sequence or gene expression, which in turn affect BP variability. Therefore, characterizing genes whose expression is associated with BP may reveal cellular processes involved in BP regulation and uncover how transcripts mediate genetic and environmental effects on BP variability. A meta-analysis of results from six studies of global gene expression profiles of BP and hypertension in whole blood was performed in 7017 individuals who were not receiving antihypertensive drug treatment. We identified 34 genes that were differentially expressed in relation to BP (Bonferroni-corrected p<0.05). Among these genes, FOS and PTGS2 have been previously reported to be involved in BP-related processes; the others are novel. The top BP signature genes in aggregate explain 5%-9% of inter-individual variance in BP. Of note, rs3184504 in SH2B3, which was also reported in GWAS to be associated with BP, was found to be a trans regulator of the expression of 6 of the transcripts we found to be associated with BP (FOS, MYADM, PP1R15A, TAGAP, S100A10, and FGBP2). Gene set enrichment analysis suggested that the BP-related global gene expression changes include genes involved in inflammatory response and apoptosis pathways. Our study provides new insights into molecular mechanisms underlying BP regulation, and suggests novel transcriptomic markers for the treatment and prevention of hypertension.
| S-EPMC4365001 | biostudies-literature
Project description:AIM:We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). DESIGN:The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: "obstructive sleep apnea", "sleep quality", "non dipping", "reduced nocturnal BP fall", "circadian BP variation", "night-time BP", and "ambulatory blood pressure monitoring". RESULTS:Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0-90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0-65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07-1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21-2.28, p < 0.001). CONCLUSIONS:The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping.
| S-EPMC6780266 | biostudies-literature
Project description:BackgroundThis review aims to investigate the efficacy of Tai Chi Chuan on subjective sleep quality among adults.MethodsWe systematically searched PubMed, Embase, Cochrane Library, Scopus, CNKI (China National Knowledge Infrastructure), and the Wanfang Database from their inception to August 2019 and identified 25 eligible studies that were published in both English and Chinese.Results24 out of 25 studies were identified to be high-quality studies according to the PEDro scale. The pooled results confirmed that Tai Chi Chuan elicited moderate improvements in subjective sleep quality (SMD = -0.512, 95% CI [-0.767, -0.257], P < 0.001). Notably, Tai Chi Chuan yielded more significant effects on sleep quality among the healthy population (SMD = -0.684, 95% CI [-1.056, -0.311], P < 0.001) than the clinical population (SMD = -0.395, 95% CI [-0.742, -0.047], P=0.026) and more benefits among the Asian population (SMD = -0.977, 95% CI [-1.446, -0.508], P < 0.001) than the American population (SMD = -0.259, 95% CI [-0.624, 0.105], P=0.164). After controlling the methodological quality of studies, it has been noted that Asians could achieve the most significant sleep-promoting benefit when Tai Chi Chuan was practiced between 60 and 90 min per session.ConclusionsAvailable data implied that subjective sleep quality was improved via Tai Chi training, but more thorough studies must be executed to ascertain our findings and optimize Tai Chi practices accordingly toward various populations.
| S-EPMC7439202 | biostudies-literature
Project description:BackgroundBody burden of mercury has been linked to hypertension in populations exposed to high mercury levels.ObjectivesWe summarized, extracted, and pooled the results of published studies that investigated mercury biomarkers and hypertension or blood pressure (BP) measurements to examine this potential relationship.MethodsWe searched PubMed, Embase, and TOXLINE and selected studies according to a priori defined inclusion criteria. Study quality was assessed by the Newcastle-Ottawa scale for cohort and case-control studies and the Quality Assessment Tool for cross-sectional studies. Study estimates were pooled using inverse-variance weighted random-effects models. Dose-response meta-analysis was performed with studies reporting hypertension and systolic BP for at least three mercury categories.ResultsA total of 29 studies were included in the meta-analysis. The pooled odds ratio (OR) for hypertension, comparing the highest and lowest mercury exposure categories, was 1.35 [95% confidence interval (CI): 0.99, 1.83] for populations with hair mercury ≥2 μg/g in comparison with the OR of 1.12 (95% CI: 0.82, 1.52) for populations with hair mercury <2 μg/g. Positive associations were also observed for highest versus lowest mercury exposure categories on systolic and diastolic BP. Heterogeneity was observed for mercury species and exposure groups across different studies. Associations estimated using different mercury biomarkers generally agree with each other in the same study. A nonlinear dose-response relationship with an inflection point at 3 μg/g was identified, for both hypertension and systolic BP.ConclusionsA significant positive association between mercury and hypertension and between mercury and BP was identified. The exposure dose is an important factor in determining the toxic effects of mercury on hypertension. https://doi.org/10.1289/EHP2863.
| S-EPMC6108832 | biostudies-literature
Project description:BackgroundManaging blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.ObjectivesThis systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.MethodsWe systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality.ResultsWe included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64-0.86, p = 0.000; I 2 = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76-1.00, p = 0.052; I 2 = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64-0.82, p = 0.000; I 2 = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43-0.66, p = 0.000; I 2 = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66-0.89, p = 0.000; I 2 = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73-0.93, p = 0.001; I 2 = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated.ConclusionsLower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.
| S-EPMC7803055 | biostudies-literature
Project description:Blunted blood pressure (BP) dipping is an established predictor of adverse cardiovascular outcomes. Although blunted BP dipping is more common in African Americans than whites, the factors contributing to this ethnic difference are not well understood. This study examined the relationships of BP dipping to ethnicity, body mass index (BMI), sleep quality, and fall in sympathetic nervous system (SNS) activity during the sleep-period.On three occasions, 128 participants with untreated high clinic BP (130-159/85-99 mm Hg) underwent assessments of 24-h ambulatory BP (ABP), sleep quality, (evaluated by sleep interview, self-report, actigraphy) and sleep-period fall in sympathetic activity (measured by waking/sleep urinary catecholamine excretion).Compared to whites (n = 72), African Americans (n = 56) exhibited higher sleep-period systolic (SBP) (P = 0.01) and diastolic BP (DBP) (P < 0.001), blunted SBP dipping (P = 0.01), greater BMI (P = 0.049), and poorer sleep quality (P = 0.02). SBP dipping was correlated with BMI (r = -0.32, P < 0.001), sleep quality (r = 0.30, P < 0.001), and sleep-period fall in sympathetic activity (r = 0.30, P < 0.001). Multiple regression analyses indicated that these three factors were independent determinants of sleep-period SBP dipping; ethnic differences in dipping were attenuated when controlling for these factors.Blunted BP dipping was related to higher BMI, poorer sleep quality, and a lesser decline in sleep-period SNS activity. Although African-American ethnicity also was associated with blunted dipping compared to whites in unadjusted analyses, this ethnic difference was diminished when BMI, sleep quality, and sympathetic activity were taken into account.
| S-EPMC3638212 | biostudies-literature