Aielo Aline N, Santos Ronaldo B, Giatti Soraya, Silva Wagner A, Parise Barbara K, Cunha Lorenna F, Souza Silvana P, Lotufo Paulo A, Bensenor Isabela M, Drager Luciano F
Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Sleep Med. 2023 Apr;104:113-120. doi: 10.1016/j.sleep.2023.02.025. Epub 2023 Mar 7.
Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index ≥15 events/hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4-itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 ± 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15-2.82), lower monthly income (OR: 1.74; 95% IC:1.01-3.0) and EDS (OR: 1.63; 95% IC:1.05-2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.
高血压是心血管疾病死亡的主要危险因素。依从性差可能部分解释了这种情况。除了传统因素外，可以想象睡眠状况如阻塞性睡眠呼吸暂停（OSA）、睡眠时间（SDUR）、嗜睡和失眠可能会导致依从性受损，但证据并不充分。来自巴西ELSA研究的连续高血压参与者进行了家庭睡眠监测和为期7天的活动记录仪监测，分别以确定OSA（呼吸暂停低通气指数≥15次/小时）和SDUR。白天过度嗜睡（EDS）和失眠分别通过Epworth嗜睡量表（ESS）和修订版临床访谈日程表（CIS-R）进行评估。使用4项Morisky问卷来评估对抗高血压治疗的依从性。共有411名患者纳入分析（平均年龄：54±8岁，47%为男性）。观察到62%的患者对抗高血压治疗的依从性为中/低。与高依从性组相比，中/低依从性的参与者中白人的比例较低（64.1%对47.8%）、受过高等教育的比例较低（50.6%对40%）以及月人均收入较低（1021.90美元对805.20美元）。相反，我们观察到EDS的发生率较高（35.9%对46.1%）。在OSA、短SDUR（<6小时）和失眠方面未观察到差异。逻辑回归分析表明，非白人种族（比值比：1.80；95%置信区间：1.15 - 2.82）、较低的月收入（比值比：1.74；95%置信区间：1.01 - 3.0）和EDS（比值比：1.63；95%置信区间：1.05 - 2.53）与抗高血压治疗的中/低依从性独立相关。有趣的是，EDS介导了腹部肥胖与依从性的关系。总之，在与睡眠相关的参数中，EDS而非OSA、短SDUR或失眠与抗高血压治疗依从性受损有关。
