Tominaga M, Tsuchihashi T, Kinoshita H, Abe I, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Am J Hypertens. 1995 Aug;8(8):773-81. doi: 10.1016/0895-7061(95)00141-B.
Twenty bedridden elderly patients with normal sleep-wake cycles were studied to evaluate the circadian variations of blood pressure, pulse rate, body core temperature, cortisol, and catecholamines with a focus on their relation to cerebral atrophy. Twenty-four-hour blood pressure (BP) and pulse rate monitorings were done with simultaneous measurement of urinary bladder temperature. Urine was also collected every 4 h to measure 17-hydroxycorticosterone and catecholamines. Based on the brain CT, frontal horn index (FHI: maximal distance between bilateral frontal horns/the corresponding width of the skull) was calculated as an index of cerebral atrophy. Analysis by the cosinor method revealed that the significant circadian rhythm with nocturnal decline was observed in only 9 patients (45%) for BP and in 13 patients (65%) for pulse rate. In contrast, 19 of 20 patients (95%) showed significant circadian rhythms of bladder temperature, with the nadirs appearing between 00:06 and 06:54. In the subgroup of mild cerebral atrophy (FHI < 0.30, n = 11), BP and pulse rate fell modestly but significantly during nighttime, whereas they did not fall in the subgroup of moderate to severe cerebral atrophy (FHI > or = 0.30, n = 9). The possibility could not be excluded that the sleep disturbance might result in the relatively high BP during nighttime. Bladder temperature, 17-hydroxycorticosteroids, and catecholamines showed significant nocturnal falls in both groups. In conclusion, nocturnal fall of BP disappeared in the bedridden elderly patients with cerebral atrophy, which cannot be explained by the change in the circadian variation of the sympathetic nervous system, cortisol, or body core temperature.
对20名睡眠 - 清醒周期正常的卧床老年患者进行了研究，以评估血压、脉搏率、体核温度、皮质醇和儿茶酚胺的昼夜变化，重点关注它们与脑萎缩的关系。进行了24小时血压（BP）和脉搏率监测，并同时测量膀胱温度。每4小时收集一次尿液，以测量17 - 羟皮质酮和儿茶酚胺。根据脑部CT计算额角指数（FHI：双侧额角之间的最大距离/颅骨相应宽度）作为脑萎缩的指标。通过余弦分析法显示，仅9名患者（45%）的血压和13名患者（65%）的脉搏率观察到有夜间下降的显著昼夜节律。相比之下，20名患者中有19名（95%）显示膀胱温度有显著昼夜节律，最低点出现在00:06至06:54之间。在轻度脑萎缩亚组（FHI < 0.30，n = 11）中，夜间血压和脉搏率适度但显著下降，而在中度至重度脑萎缩亚组（FHI >或= 0.30，n = 9）中则没有下降。不能排除睡眠障碍可能导致夜间血压相对较高的可能性。两组的膀胱温度、17 - 羟皮质类固醇和儿茶酚胺均显示夜间显著下降。总之，脑萎缩的卧床老年患者夜间血压下降消失，这不能用交感神经系统、皮质醇或体核温度的昼夜变化改变来解释。
