Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State University, College of Medicine, Hershey, PA (N.M.-G., M.L., S.L.C., A.N.V., E.O.B., J.F.-M.).
Department of Public Health Sciences, Penn State University, College of Medicine, Hershey, PA (F.H., J.L., D.L.).
Hypertension. 2023 Apr;80(4):861-871. doi: 10.1161/HYPERTENSIONAHA.122.20398. Epub 2023 Mar 6.
Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents.
We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break.
Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP ( interaction=0.007) and diastolic blood pressure ( interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP ( interaction=0.026) and diastolic blood pressure ( interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP ( interaction=0.034).
A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.
尽管已有研究表明睡眠不足与肥胖相关的血压升高有关，但睡眠的昼夜节律时间已成为新的危险因素。我们假设，睡眠中点（衡量睡眠昼夜节律时间的指标）的偏差会改变内脏脂肪与青少年血压升高之间的关系。
我们研究了宾夕法尼亚州立大学儿童队列中的 303 名受试者（16.2±2.2 岁；47.5%为女性；21.5%为少数族裔）。通过 7 个晚上的活动记录仪测量计算睡眠持续时间、中点、变异性和规律性。通过双能 X 射线吸收法测量内脏脂肪组织（VAT）。在坐姿下测量收缩压（SBP）和舒张压水平。多变量线性回归模型检验了睡眠中点及其规律性作为 VAT 对 SBP/舒张压水平的影响因素，同时调整了人口统计学和睡眠相关变量。还检查了这些关联作为在校或休息时间的函数。
在校时间和休息时间，VAT 与睡眠不规律（ interaction=0.007 和 interaction=0.022）而不是睡眠中点之间存在显著交互作用，与 SBP（ interaction=0.026）和舒张压（ interaction=0.043）之间存在显著交互作用，而在校时间和休息时间的 VAT 与睡眠不规则性（ interaction=0.034）之间存在显著交互作用，与 SBP 之间存在显著交互作用。
在校时间和休息时间睡眠中点的延迟和不规律，分别增加了 VAT 对青少年血压升高的影响。这些数据表明，睡眠昼夜节律时间的偏差导致肥胖相关的心血管后果增加，并且其不同的指标需要在青少年不同的适应条件下进行测量。
