Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY; Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY.
Sleep center of excellence, Department of Medicine, Columbia University Irving Medical Center, New York, NY.
Am Heart J. 2020 May;223:12-22. doi: 10.1016/j.ahj.2020.02.006. Epub 2020 Feb 8.
Studies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (<4 hours a night), and lack of attention to psychological distress as a possible mediator.
A community-based cohort was assembled with 237 women (age 34.1 ± 13.5 years; body mass index 25.4 ± 5.4 kg/m), and a randomized, crossover, intervention study was conducted in 41 women (24 completed: age 30.2 ± 6.5 years; body mass index 24.3 ± 2.8 kg/m) to determine the causal effect of SR on BP. Sleep was maintained as usual (HS) or reduced by 1.5 hours a night (SR) for 6 weeks. In the cohort, associations between sleep and psychosocial factors were evaluated using multivariable models adjusted for demographic and clinical confounders. In the intervention study, in-office BP was measured weekly; ambulatory BP was measured at end point. Psychological factors were assessed at baseline and end point. Mixed-model analyses with total sleep time (TST, main predictor), week and fraction of time spent in physical activity (covariates), and subject (random effect) were performed.
Among the community cohort, higher perceived stress, stressful events and distress, and lower resilience were associated with shorter sleep, worse sleep quality, and greater insomnia symptoms (P < .05). In the intervention, systolic BP increased as TST decreased (TST × week interaction, [coefficient ± standard error] -0.0097 ± 0.0046, P = .036). Wake ambulatory diastolic blood pressure (-0.059 ± 0.022, P = .021) and mean arterial pressure (-0.067 ± 0.023, P = .018) were higher after SR versus HS. Psychological distress variables were not affected by TST and did not mediate the effects of SR on BP.
These results suggest that SR influences CVD risk in women via mechanisms independent of psychological stressors.
评估睡眠限制（SR）对血压（BP）影响的研究受到研究时间短、极端 SR（每晚<4 小时）以及缺乏关注心理困扰作为可能的中介因素的限制。
组建了一个基于社区的队列，其中包括 237 名女性（年龄 34.1±13.5 岁；体重指数 25.4±5.4kg/m），并对 41 名女性进行了随机、交叉干预研究，以确定 SR 对 BP 的因果影响。睡眠保持正常（HS）或每晚减少 1.5 小时（SR）持续 6 周。在队列中，使用多变量模型评估睡眠与心理社会因素之间的关系，模型调整了人口统计学和临床混杂因素。在干预研究中，每周测量一次诊室血压；在终点测量动态血压。在基线和终点评估心理因素。使用混合模型分析，总睡眠时间（TST，主要预测因素）、周和体力活动时间比例（协变量）和受试者（随机效应）。
在社区队列中，较高的感知压力、压力事件和困扰以及较低的适应力与较短的睡眠时间、较差的睡眠质量和更大的失眠症状相关（P<.05）。在干预组中，随着 TST 的减少，收缩压升高（TST×周交互作用，[系数±标准误差]-0.0097±0.0046，P=.036）。与 HS 相比，清醒时的舒张压（-0.059±0.022，P=.021）和平均动脉压（-0.067±0.023，P=.018）升高。TST 对心理困扰变量没有影响，也不能介导 SR 对 BP 的影响。
这些结果表明，SR 通过独立于心理压力源的机制影响女性的 CVD 风险。
