A Systematic Assessment of the Association of Polysomnographic Indices with Blood Pressure: The Multi-Ethnic Study of Atherosclerosis (MESA)
A Systematic Assessment of the Association of Polysomnographic Indices with Blood Pressure: The Multi-Ethnic Study of Atherosclerosis (MESA)
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DOI：
10.5665/sleep.4576
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发表时间：
2015-04-01
期刊：
影响因子：
5.6
通讯作者：
Redline, Susan
中科院分区：
文献类型：
--
作者：
Dean, Dennis A., II;Wang, Rui;Redline, Susan
研究目的：血压（BP）可能会受到多种睡眠障碍的不利影响，包括睡眠碎片化、低氧血症、呼吸障碍和周期性肢体运动。我们的目标是在基于人群的样本中确定哪些多导睡眠图指数与收缩压和舒张压 (SBP、DBP) 水平最密切且一致。设计：对多种族动脉粥样硬化研究 (MESA) 的 2,040 名参与者的数据进行横断面分析，这些参与者在 2011-2013 年 MESA 考试 5 中接受了多导睡眠图。设置：多地点队列研究。参与者：参与者平均年龄为 68 岁（54% 为女性；28% 为非裔美国人，24% 为西班牙裔，11% 为中国人）。 测量：确定了 32 个候选多导睡眠图预测因子，代表呼吸障碍频率、低氧血症、睡眠结构和周期性肢体运动等领域。使用聚类分析来减少变量。使用逐步回归推导出针对潜在混杂因素进行调整的统计模型。使用交叉验证技术选择最终模型。结果：使用 4% 饱和度低通气标准 (AHI4P) 定义的呼吸暂停低通气指数 (AHI) 与 SBP 水平的相关性最为一致。 AHI 和周期性肢体运动指数（与唤醒相关；PLMIA）与 DBP 显着相关。无睡眠呼吸暂停 (AHI4P = 0) 和中度严重睡眠呼吸暂停 (AHI4P = 30) 的个体之间 SBP 和 DBP 水平的估计调整差异分别为 2.2 mm Hg 和 1.1 mm Hg。 PLMIA 每增加 10 个单位，DBP 就会增加 1.2 mm Hg。结论：我们的结果支持使用目前推荐的呼吸暂停低通气指数定义作为血压风险的标志，并表明伴随唤醒的肢体运动测量也与舒张压独立相关。
Study Objective: Blood pressure (BP) may be adversely affected by a variety of sleep disturbances, including sleep fragmentation, hypoxemia, respiratory disturbances, and periodic limb movements. We aim to identify which polysomnography indices are most strongly and consistently associated with systolic and diastolic blood pressure (SBP, DBP) levels in a population-based sample.Design: Cross-sectional analysis of data from 2,040 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent polysomnography at MESA Exam 5 in 2011-2013.Setting: Multisite cohort study.Participants: Participants were mean age 68 y (54% females; 28% African American, 24% Hispanic, 11% Chinese).Measurements: Thirty-two candidate polysomnography predictors were identified representing the domains of breathing disturbance frequency, hypoxemia, sleep architecture, and periodic limb movements. Cluster analysis was used for variable reduction. Statistical models, adjusted for potential confounders, were derived using stepwise regression. Final models were selected using cross-validation techniques.Results: The apnea-hypopnea index (AHI) defined using a 4% desaturation hypopnea criterion (AHI4P) was most consistently associated with SBP level. The AHI and periodic limb movement index (associated with arousals; PLMIA) were significantly associated with DBP. Estimated adjusted differences in SBP and DBP levels between an individual with no sleep apnea (AHI4P = 0) and one with moderately severe sleep apnea (AHI4P = 30) were 2.2 mm Hg and 1.1 mm Hg, respectively. Each 10-unit increase in the PLMIA was associated with an increase in DBP of 1.2 mm Hg.Conclusion: Our results support the use of a currently recommended apnea-hypopnea index definition as a marker of blood pressure risk and indicate that measurement of limb movements with arousals is also independently associated with diastolic blood pressure.