Sleep Research and Treatment Center, Pennylvania State University College of Medicine, Department of Psychiatry H073, 500 University Dr, Hershey, PA 17033, USA.
Hypertension. 2012 Oct;60(4):929-35. doi: 10.1161/HYPERTENSIONAHA.112.193268. Epub 2012 Aug 14.
Insomnia with objective short sleep duration appears to be a biologically more severe phenotype of the disorder. No longitudinal study to date has examined the association of this type of insomnia with incident hypertension using polysomnography. From a random, general population sample of 1741 adults of the Penn State Cohort, 1395 were followed-up after 7.5 years, and 786 did not have hypertension at baseline. Hypertension was determined by a self-report of receiving treatment for high blood pressure. Chronic insomnia was defined as a complaint of insomnia lasting ≥1 year, whereas poor sleep was defined as moderate-to-severe sleep difficulties. All of the subjects underwent 8-hour polysomnography. Sleep-disordered breathing (SDB) was defined as an obstructive apnea/hypopnea index≥5. We used the median polysomnographic percentage of sleep time to define short sleep duration (ie, <6 hours). We controlled for sex, race, age, caffeine, cigarettes and alcohol consumption, depression, sleep-disordered breathing, diabetes mellitus, obesity, and blood pressure in our analyses. Compared with normal sleepers who slept≥6 hours, the highest risk for incident hypertension was in chronic insomniacs with short sleep duration (odds ratio, 3.8 [95% CI, 1.6-9.0]). The risk for incident hypertension in poor sleepers with short sleep duration was significantly increased but became marginally significant after controlling for obesity (odds ratio, 1.6 [95% CI, 0.9-2.8]). Chronic insomnia with short sleep duration is associated with an increased risk for incident hypertension in a degree comparable to sleep-disordered breathing. Objective short sleep duration in insomnia may serve as a useful predictor of the biological severity of the disorder.
失眠症患者的客观睡眠时间较短，其失眠症的生物学特征似乎更为严重。目前尚无研究采用多导睡眠图来观察这种类型的失眠症与高血压发生之间的相关性。从宾夕法尼亚州队列的 1741 名成年人中随机抽取的一般人群样本中，1395 人在 7.5 年后进行了随访，786 人在基线时没有高血压。高血压是通过自我报告接受高血压治疗来确定的。慢性失眠症的定义为失眠持续≥1 年的抱怨，而睡眠不佳则定义为中度至重度睡眠困难。所有受试者均进行了 8 小时多导睡眠图检查。睡眠呼吸障碍（SDB）定义为阻塞性呼吸暂停/低通气指数≥5。我们使用多导睡眠图睡眠时间的中位数来定义睡眠时间短（即<6 小时）。我们在分析中控制了性别、种族、年龄、咖啡因、香烟和酒精摄入量、抑郁、睡眠呼吸障碍、糖尿病、肥胖和血压。与睡眠≥6 小时的正常睡眠者相比，睡眠时间短的慢性失眠症患者发生高血压的风险最高（比值比，3.8[95%CI，1.6-9.0]）。睡眠时间短的睡眠不佳者发生高血压的风险显著增加，但在控制肥胖后，其风险变得略微显著（比值比，1.6[95%CI，0.9-2.8]）。睡眠时间短的慢性失眠症与高血压的发生风险增加相关，其严重程度与睡眠呼吸障碍相当。失眠症患者的客观睡眠时间较短可能是该疾病生物学严重程度的有用预测指标。
