Objective short sleep duration modifies the relationship between hypertension and all-cause mortality.
Objective short sleep duration modifies the relationship between hypertension and all-cause mortality.
复制标题
客观短睡眠持续时间修改了高血压与全因死亡率之间的关系。
DOI：
10.1097/hjh.0000000000001253
复制
发表时间：
2017-04
影响因子：
4.9
通讯作者：
Bixler EO
中科院分区：
文献类型：
--
作者：
Fernandez-Mendoza J;He F;Vgontzas AN;Liao D;Bixler EO
睡眠时间短与心血管疾病的发病率和死亡率有关。然而，以前的研究局限于使用主观睡眠测量，并将睡眠时间作为唯一的独立预测因素。因此，睡眠持续时间在预测死亡率中的作用仍然没有得到很好的理解。我们认为，客观睡眠时间是高血压和全因死亡率之间关系的影响因素。我们在宾夕法尼亚州立大学成人队列研究中解决了这个问题，这是一个随机的一般人群样本，共有1741名男性和女性（48.7±13.5岁），他们在睡眠实验室接受了研究，随访时间为15.5±4.1年。根据SBP和DBP（≥140/≥90 mmHg）或使用抗高血压药物定义高血压。多导睡眠图睡眠持续时间被分为三个有临床意义的类别。我们使用多因素logistic回归检验了高血压和多导睡眠图睡眠时间对全因死亡率的影响，同时控制了几个潜在的混杂因素（P值= 0.03）。与高血压相关的全因死亡率的比值（95%置信区间）分别为1.77（1.07-2.92）、2.78（1.47-5.24）和3.93（2.22-6.95），睡眠至少6、5-6和5小时或更少的个体。与高血压相关的死亡风险以剂量反应方式增加，作为睡眠时间缩短的函数。高血压患者睡眠时间短可能是中枢自主神经功能紊乱程度的标志。未来的流行病学研究应该使用病因特异性死亡率来检查这种效应的改变，而未来的临床试验应该检查延长睡眠时间是否会改善高血压患者的预后。
Short sleep duration has been associated with cardiovascular morbidity and mortality. However, previous studies were limited by using subjective sleep measures and treating sleep duration as a sole, independent predictor. Therefore, the role of sleep duration in predicting mortality is still not well understood. We posit that objective sleep duration is an effect modifier of the relationship between hypertension and all-cause mortality. We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1741 men and women (48.7±13.5 years) who were studied in the sleep laboratory and followed up for 15.5±4.1 years. Hypertension was defined on the basis of SBP and DBP (≥140/≥90 mmHg) or use of antihypertensive medication. Polysomnographic sleep duration was classified into three clinically meaningful categories. We tested the interaction between hypertension and polysomnographic sleep duration on all-cause mortality using multiple logistic regression while controlling for several potential confounders (P value = 0.03). The odds (95% confidence interval) of all-cause mortality associated with hypertension were 1.77 (1.07–2.92), 2.78 (1.47–5.24), and 3.93 (2.22–6.95) for individuals who slept at least 6, 5–6, and 5 h or less, respectively. The risk of mortality associated with hypertension increases in a dose–response manner as a function of shorter sleep duration. Short sleep in hypertensive individuals may be a marker of the degree of central autonomic dysfunction. Future epidemiological studies should examine this effect modification using cause-specific mortality, whereas future clinical trials should examine whether lengthening sleep improves the prognosis of individuals with hypertension.