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

摘要本研究旨在探讨农村社区老年人动态血压变化、抑郁状态和睡眠障碍之间的关系。对2756名65岁以上独居老人进行问卷调查，明确独居老人抑郁状态和睡眠障碍的特征，并对41名老年志愿者进行抑郁状态和动态血压变化及活动仪睡眠觉醒判断。考虑到独居老人抑郁状态和睡眠障碍的特点，我们得出本研究的结果如下：(1)高血压患者在清醒期和睡眠期的收缩压和舒张压平均值均高于非高血压患者。(2)自述睡眠障碍对动态血压变化无显著影响。(3)夜间睡眠时舒张压变化系数和脉搏率变化系数与醒时活动图持续时间呈显著相关。(4)自述抑郁状况与活动描记睡眠障碍指数无显著相关。(5)与血压正常者相比，高血压患者舒张压夜间下降率较小。综上所述，抑郁状态和睡眠障碍可能与社区居住老年人的动态血压变化独立相关，并且这些关联可能因高血压的存在而改变。

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.