BLOOD-PRESSURE CHANGES DURING DAYTIME SLEEP AND COMPARISON OF DAYTIMEAND NIGHTTIME SLEEP-RELATED BLOOD-PRESSURE CHANGES IN PATIENTS WITH CHRONIC-RENAL-FAILURE

Citation
Sj. Rosansky et al., BLOOD-PRESSURE CHANGES DURING DAYTIME SLEEP AND COMPARISON OF DAYTIMEAND NIGHTTIME SLEEP-RELATED BLOOD-PRESSURE CHANGES IN PATIENTS WITH CHRONIC-RENAL-FAILURE, Journal of the American Society of Nephrology, 4(5), 1993, pp. 1172-1177
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Urology & Nephrology
ISSN journal
1046-6673
Volume
4
Issue
5
Year of publication
1993
Pages
1172 - 1177
Database
ISI
SICI code
1046-6673(1993)4:5<1172:BCDDSA>2.0.ZU;2-T
Abstract
Blood pressure has a diurnal pattern primarily related to activity and sleep. Chronic renal failure patients may lack the normal nocturnal d ecline in blood pressure during sleep. In 33 subjects (14 with normal renal function and 19 with renal dysfunction), the relationship betwee n depth of daytime sleep, as determined by electroencephalographic sle ep phase, and change in mean arterial blood pressure (MAP) and heart r ate measured oscillometrically, was correlated. In 15 chronic renal fa ilure patients, the effect of daytime and nighttime sleep on MAP and h eart rate was compared. The percent change in night asleep versus day awake MAP and heart rate was measured (with Space Labs ambulatory bloo d pressure monitors) and compared with the percent change in daytime s leep-related MAP and heart rate measured during a daytime sleep electr oencephalographic study. During daytime sleep, MAP changes are not sig nificantly different in the normal versus renal dysfunction groups. In the 33 study subjects, MAP declines progressively from the upright po sition to Phase 3/4 sleep (118 +/- 3.3 to 106 +/- 3.6 mm Hg). The larg est decline occurs between the upright to recumbent position, before s leep. Heart rate declines moving from the upright to recumbent positio n, 76 +/- 2.3 to 70 +/- 2.1 beats/min, but does not decline further wi th sleep. In 15 chronic renal failure patients, heart rate (10.8 +/- 2 .8%; P < 0.05), but not MAP, declines during nighttime sleep. Both MAP (7.7 +/- 3.3%) and heart rate (5.4 +/- 1.9%) decline significantly du ring daytime sleep. The responses of MAP and heart rate to daytime and nighttime sleep were in opposite directions in 3 of 15 subjects. In c onclusion, MAP declines progressively during daytime sleep with succes sively deeper levels of sleep. Movement from the upright to the recumb ent position accounts for a large part of the decline. In patients wit h chronic renal failure, MAP and heart rate responses to daytime and n ighttime sleep may be in opposite directions. Future physiologic studi es are needed to explore the mechanisms of daytime and nighttime sleep -related hemodynamic changes.