The relationship among ambulatory blood pressure variations, depressive status and sleep disturbance in community-dwelling elderly persons in a rural area.

本研究的目的是探讨农村社区老年人动态血压变化、抑郁状态与睡眠障碍的关系。为明确独居老年人抑郁状态和睡眠障碍的特征，对2756名65岁以上独居老年人进行问卷调查，并对41名老年志愿者进行抑郁状态和动态血压变化与睡眠-觉醒判断的动态监测。考虑到独居老年人抑郁状态和睡眠障碍的特点，我们获得了以下研究结果。(1)高血压患者清醒期和睡眠期的平均收缩压和舒张压均高于非高血压组。(2)自述睡眠障碍对动态血压变化无显著影响。(3)夜间活动图清醒时间与舒张压、脉率的变异系数呈显著正相关。(4)自报抑郁状况与睡眠障碍指数之间无显著相关。(5)与血压正常者相比，高血压患者舒张压夜间下降率较低。综上所述，抑郁状态和睡眠障碍可能独立地与社区老年人的动态血压变化有关，而高血压的存在可能会改变这种联系。

The objective of the present study was to investigate the relationship among ambulatory blood pressure variations, depressive status and sleep disturbance in community-dwelling elder persons in a rural area. The questionnaire survey was conducted in 2,756 elderly persons aged over 65 who lived at home to clarify characteristics of elderly living alone on depressive status and sleep disturbance, and then 41 elderly volunteers were examined on the depressive status and ambulatory blood pressure variations with sleep-awake judgments by actigraphs. Taking characteristics of lived-alone elderly on depressive status and sleep disturbance into consideration, we obtained results of this study as follows. (1) Both average values of systolic and diastolic blood pressure in subjects with hypertension were higher during an awake-stage and a sleep-stage than without hypertension. (2) There was no significant effect of self-reported sleep disturbance to ambulatory blood pressure variations. (3) The significant correlation was observed between the duration of awake-time by actigraphs and the coefficient of variation in diastolic blood pressure and pulse rate during night sleep. (4) No significant correlation was observed between self-reported depressive conditions and sleep disturbance indices by actigraphs. (5) Hypertensive subjects had less night decrease rate in a diastolic blood pressure in comparison to normotensives. In conclusion, the depressive status and the sleep disturbance may independently associate with ambulatory blood pressure variations in community-dwelling elder persons, and those associations may be modified by the presence of hypertension.