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- Title
Classification of blood pressure during sleep impacts designation of nocturnal nondipping.
- Authors
Mortazavi, Bobak J.; Martinez-Brockman, Josefa L.; Tessier-Sherman, Baylah; Burg, Matthew; Miller, Mary; Nowroozilarki, Zhale; Adams, O. Peter; Maharaj, Rohan; Nazario, Cruz M.; Nunez, Maxine; Nunez-Smith, Marcella; Spatz, Erica S.
- Abstract
The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertension study with complete ambulatory blood pressure monitor and sleep data, the concordance for nocturnal nondipping across methods was 0.54 by Fleiss' Kappa (depending on the method, 36 to 51 participants classified as having nocturnal nondipping). Sleep quality for participants with dipping versus nondipping was significantly different for total sleep length when wearing the ambulatory blood pressure monitor (shorter sleep duration) versus not (longer sleep duration), although there were no differences in sleep efficiency or disturbances. These findings indicate that consideration of sleep time measurements is critical for interpreting ambulatory blood pressure. As technology advances to detect blood pressure and sleep patterns, further investigation is needed to determine which method should be used for diagnosis, treatment, and future cardiovascular risk. Author summary: The identification of nocturnal nondipping hypertension has been shown to be a risk factor for future cardiovascular disease, however, requires the accurate capture of blood pressure measurements during wake and sleep periods. We found that, while some cases were clear cases of nocturnal nondipping hypertension, there were a number of cases in which classification of an individual as having nocturnal nondipping hypertension depended upon the inclusion or exclusion of a few readings based upon sleep status. We tested several classification methods and found only partial concordance for the cases classified as nocturnal nondipping. We noted that existing literature also uses pre-defined periods for sleep, participant self-reports for sleep timing, or automated actigraphy, and conclude that future study design must carefully consider sensors to determine wake versus sleep periods and how to treat blood pressure readings taken during sleep disturbances. In addition, we also found that the ambulatory blood pressure monitor was associated with shorter periods of sleep, which may influence classification of nocturnal nondipping in studies that only capture one night of sleep.
- Subjects
BARBADOS; TRINIDAD &; Tobago; PUERTO Rico; UNITED States Virgin Islands; BLOOD pressure; SLEEP quality; ACADEMIC medical centers; ACTIGRAPHY; SLEEP; INDEPENDENT living; LONGITUDINAL method
- Publication
PLoS Digital Health, 2023, Vol 1, Issue 6, p1
- ISSN
2767-3170
- Publication type
Article
- DOI
10.1371/journal.pdig.0000267