Zhang Jun, Wang Cheng, Gong Wenyu, Ye Zengchun, Tang Ying, Zhao Wenbo, Peng Hui, Lou Tanqi
Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Division of Nephrology, Department of medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Nephrology (Carlton). 2017 Sep;22(9):690-698. doi: 10.1111/nep.12839.
This study was designed to evaluate the relationship between sleep quality and hypertension and to determine if there was an association between nondipper blood pressure (BP) and sleep quality in chronic kidney disease (CKD) patients.
A total of 775 pre-dialysis CKD patients (314 normal BP patients, 461 hypertension patients) defined as dippers or nondippers by ambulatory BP monitoring were recruited for this study. Demographics and clinical correlates were collected, including body mass index, estimated glomerular filtration rate (eGFR) and other measures. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).
A total of 185 (58.9%) patients with normal BP and 341 (74.0%) hypertensive patients had a nondipper BP pattern. The hypertension group had a higher prevalence of the nondipper BP pattern, smoking, alcohol intake and diabetes mellitus (DM) and lower eGFR levels and poorer sleep quality than the normal BP group. Patients with the nondipper BP pattern had lower haemoglobin, worse renal function and poorer sleep quality when compared with hypertensive CKD patients with the dipping BP pattern. PSQI scores were significantly associated with the rate of nocturnal BP decline (P < 0.05) in the hypertension group but not in the normal BP group. Poor sleep quality was an independent factor affecting BP pattern in hypertensive CKD patients using multivariate linear and logistic regression analyses. There was no association between sleep quality and hypertension in CKD patients after multivariate logistic regression analyses.
Poor sleep quality, which is commonly observed in pre-dialysis CKD patients, is an independent associated factor of the nondipper BP pattern in hypertensive CKD patients. No association was found between poor sleep and nondipper BP in normotensive patients.
本研究旨在评估睡眠质量与高血压之间的关系，并确定慢性肾脏病（CKD）患者中血压非勺型与睡眠质量之间是否存在关联。
本研究招募了775例接受透析前的CKD患者（314例血压正常患者，461例高血压患者），通过动态血压监测将其定义为勺型或非勺型。收集了人口统计学和临床相关数据，包括体重指数、估计肾小球滤过率（eGFR）及其他指标。使用匹兹堡睡眠质量指数（PSQI）测量睡眠质量。
共有185例（58.9%）血压正常患者和341例（74.0%）高血压患者呈现血压非勺型模式。高血压组血压非勺型模式、吸烟、饮酒和糖尿病（DM）的患病率更高，eGFR水平更低，睡眠质量比血压正常组更差。与血压勺型模式的高血压CKD患者相比，血压非勺型模式的患者血红蛋白水平更低，肾功能更差，睡眠质量更差。在高血压组中，PSQI评分与夜间血压下降率显著相关（P<0.05），而在血压正常组中则无此关联。使用多变量线性和逻辑回归分析显示，睡眠质量差是影响高血压CKD患者血压模式的独立因素。多变量逻辑回归分析后发现，CKD患者的睡眠质量与高血压之间无关联。
在接受透析前的CKD患者中常见的睡眠质量差，是高血压CKD患者血压非勺型模式的独立相关因素。在血压正常的患者中，未发现睡眠质量差与血压非勺型之间存在关联。
