Overweight and obesity are associated with arterial stiffness and central systolic blood pressure in children with sleep disordered breathing

1. The aim of the study was to assess the effect of ambulatory monitoring of blood pressure on sleep and on blood pressure in middle-aged patients. 2. Nine consecutive patients (seven men, two women; mean age 57 years) complaining of snoring and various degrees of excessive daytime somnolence were studied. Five patients were normotensive and four were being treated for hypertension. During one night standard laboratory polysomnography was performed with monitoring of blood pressure by a silent ambulatory monitor and continuous infrared blood pressure by photoplethysmography. 3. Ambulatory blood pressure significantly disturbs sleep architecture, causing EEG arousals in 64% of measurements, and induces a significant rise in blood pressure during systolic pressure measurement by the ambulatory monitor (rise in systolic pressure, 13.7 ± 15.9 mmHg, P > 0.001; rise in diastolic pressure, 3.7 ± 8.2 mmHg, P > 0.01). At the time of diastolic measurement, blood pressure had returned to the preinflation value. The rise in systolic blood pressure was higher when an arousal was associated with cuff inflation (P > 0.001). This rise in blood pressure is probably the consequence of sympathetic nervous system activation. 4. We conclude that ambulatory blood pressure recordings of systolic blood pressure during sleep should be interpreted with caution as systolic blood pressure may be significantly increased in patients suspected of suffering from sleep-disordered breathing.

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Abstract 10245: Arterial Stiffness, Central Pulsatile Hemodynamic Load and Orthostatic Hypotension: A Cross-sectional Survey of Community Residents in Chengdu

Circulation ◽

10.1161/circ.132.suppl_3.10245 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kai Liu ◽

Xiaoping Chen ◽

Si Wang ◽

Shixi Wan ◽

Yufei Zhou ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Systolic Blood Pressure ◽

Orthostatic Hypotension ◽

Multiple Logistic Regression Analysis ◽

The Elderly ◽

Discriminatory Power ◽

Receiver Operating Curve ◽

Cross Sectional Survey ◽

Central Systolic Blood Pressure

Introduction: Orthostatic hypotension (OH) is an independent risk factor for cardiovascular morbidity and often unrecognized in the elderly. The association between measures of central pulsatile hemodynamic load or arterial stiffness with OH is unclear. This study evaluated the usefulness of these indexes to identify OH. Hypothesis: We hypothesize that direct measures of central pulsatile hemodynamic load (e.g. central systolic blood pressure) and arterial stiffness (pulse wave velocity) both associated with OH. And Measures of central pulsatile hemodynamic load may represent a better indicator of OH. Methods: A sample of 1099 participants was recruited from the general population who attended health check-ups. Questionnaire, physical examination and laboratory tests were performance by a standard protocol. To assess the correlation between central hemodynamic indexes and the probability of OH, multiple logistic regression analysis was used to estimate the odds ratio in different models, and the discriminatory power of hemodynamic indexes for OH was assessed by the area under the receiver operating curve (ROC). Results: The prevalence of OH in this population was 5.6 %. Compared with those without OH, OH subjects had a higher age, SBP in sitting position, BP in supine position, brachial-ankle PWV (BaPWV) and central systolic blood pressure (CSBP) (all P<0.05). After adjusting for potential confounders, both CSBP (OR=1.039, 95%CI: 1.016-1.062, P=0.001) and BaPWV (OR=1.259, 95%CI: 1.130-1.402, P< 0.001) were significantly positive correlated with OH. However, in subgroup analysis, CSBP (OR=1.017, 95%CI: 0.985-1.050, P=0.310) was insignificantly associated with OH in non hypertension subgroup. In addition, BaPWV seemed to be a better discriminatory power than CSBP in both two subgroups (BaPWVAUC-CSBPAUC =0.127, 95%CI: 0.020-0.233, P=0.02 in non hypertension group; BaPWVAUC-CSBPAUC =0.118, 95%CI: -0.030-0.267, P=0.117 in hypertension group). Conclusion: BaPWV appears to be a better indicator of OH in the elderly. If a patient’s BaPWV is greater than 18m/s, Clinicians should better to carry out supine to standing blood pressures measurement in routine clinical practice.

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