Huang Yuli, Mai Weiyi, Hu Yunzhao, Wu Yanxian, Song Yuanbin, Qiu Ruofeng, Dong Yugang, Kuang Jian
Department of Cardiology, the Affiliated Hospital at Shunde (the First People's Hospital of Shunde), Southern Medical University, Guangzhou, PR China.
Blood Press Monit. 2011 Jun;16(3):117-23. doi: 10.1097/MBP.0b013e328346a8b4.
It has been reported that poor sleep quality is associated with nondipping hypertension, but the underlying mechanisms were not reported. This study was carried out to evaluate whether poor sleep quality is associated with stress status and sympathetic nervous system activation in nondippers.
A total of 307 Chinese essential hypertensive patients were defined as dippers or nondippers by ambulatory blood pressure monitoring. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and stress status was assessed by Perceived Stress Scale (PSS). The levels of epinephrine and norepinephrine were examined to investigate the underlying mechanisms.
A total of 204 (66.4%) and 103 cases (33.6%) were found to be dippers and nondippers, respectively. Nondippers were with poorer sleep quality (P<0.05), more stressful status (P<0.05), and with an increased activity of sympathetic nervous system (P<0.01). The decline of systolic BP (SBP) and diastolic BP (DBP) at night was inversely related with the PSQI score (r=-0.469, P<0.01 and r=-0.421, P<0.01), PSS score (r=-0.432, P<0.01 and r=-0.404, P<0.01), epinephrine (r=-0.304, P<0.05 and r=-0.293, P<0.05), and norepinephrine (r=-0.321, P<0.05 and r=-0.357, P<0.05). Multiple logistic regression analyses showed that older age [odds ratio (OR): 1.69; 95% confidence interval (CI): 1.22-2.43], PSQI score (OR: 2.78; 95% CI: 1.65-6.87), and PSS score (OR: 2.43; 95% CI: 1.56-5.93) were independently correlated with the nondipping pattern.
Poor sleep quality and stressful status were closely associated with higher activation of sympathetic nervous system, and they are independent predictors of nondipping hypertension.
据报道，睡眠质量差与非勺型高血压有关，但潜在机制尚未见报道。本研究旨在评估睡眠质量差是否与非勺型高血压患者的应激状态和交感神经系统激活有关。
通过动态血压监测将307例中国原发性高血压患者分为勺型或非勺型。采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，采用感知应激量表（PSS）评估应激状态。检测肾上腺素和去甲肾上腺素水平以探究潜在机制。
共发现204例（66.4%）为勺型，103例（33.6%）为非勺型。非勺型患者睡眠质量较差（P<0.05），应激状态更高（P<0.05），交感神经系统活性增加（P<0.01）。夜间收缩压（SBP）和舒张压（DBP）的下降与PSQI评分（r=-0.469，P<0.01和r=-0.421，P<0.01）、PSS评分（r=-0.432，P<0.01和r=-0.404，P<0.01）、肾上腺素（r=-0.304，P<0.05和r=-0.293，P<0.05）及去甲肾上腺素（r=-0.321，P<0.05和r=-0.357，P<0.05）呈负相关。多因素logistic回归分析显示，年龄较大[比值比（OR）：1.69；95%置信区间（CI）：1.22-2.43]、PSQI评分（OR：2.78；95%CI：1.65-6.87）和PSS评分（OR：2.43；95%CI：1.56-5.93）与非勺型模式独立相关。
睡眠质量差和应激状态与交感神经系统更高的激活密切相关，它们是非勺型高血压的独立预测因素。
