Thomas S Justin, Calhoun David
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
J Am Soc Hypertens. 2017 Feb;11(2):122-129. doi: 10.1016/j.jash.2016.11.008. Epub 2016 Dec 29.
Blood pressure (BP) varies over 24 hours. During normal sleep, BP typically decreases by 10% or more. Research suggests that disordered sleep, particularly sleep deprivation and obstructive sleep apnea, is associated with increased BP and risk of hypertension. Less is known about the relationship between insomnia and hypertension. Population-based studies have reported an association between insomnia symptoms and both prevalent and incident hypertension, particularly in the context of short sleep duration. Furthermore, a number of mechanisms have been proposed to explain the relationship between insomnia and hypertension. However, few studies have examined these proposed mechanisms, and even fewer clinical trials have been conducted to determine if improved sleep improves BP and/or reverses a nondipping BP pattern. Methodological concerns, particularly with respect to the diagnosis of insomnia, no doubt impact the strength of any observed association. Additionally, a large majority of studies have only examined the association between insomnia symptoms and clinic BP. Therefore, future research needs to focus on careful consideration of the diagnostic criteria for insomnia, as well as inclusion of either home BP or ambulatory BP monitoring. Finally, clinical trials aimed at improving the quality of sleep should be conducted to determine if improved sleep impacts 24-hour BP.
血压（BP）在24小时内会有所变化。在正常睡眠期间，血压通常会下降10%或更多。研究表明，睡眠紊乱，尤其是睡眠剥夺和阻塞性睡眠呼吸暂停，与血压升高和高血压风险增加有关。关于失眠与高血压之间的关系，人们了解得较少。基于人群的研究报告了失眠症状与高血压的患病率和发病率之间的关联，尤其是在睡眠时间较短的情况下。此外，已经提出了一些机制来解释失眠与高血压之间的关系。然而，很少有研究检验这些提出的机制，进行临床试验以确定改善睡眠是否能改善血压和/或逆转非勺型血压模式的研究更少。方法学上的问题，特别是关于失眠的诊断，无疑会影响任何观察到的关联的强度。此外，绝大多数研究只考察了失眠症状与诊所血压之间的关联。因此，未来的研究需要专注于仔细考虑失眠的诊断标准，以及纳入家庭血压或动态血压监测。最后，应该进行旨在改善睡眠质量的临床试验，以确定改善睡眠是否会影响24小时血压。
