Nocturnal pulse wave attenuation is associated with office blood pressure in a population based cohort

Sleep Med. 2009 Sep;10(8):836-43. doi: 10.1016/j.sleep.2008.10.001. Epub 2009 Jan 9.


Objective and background: Pulse wave amplitude (PWA) derived from the digital vascular bed has been used in sleep studies. The nocturnal attenuation of PWA has been shown to reflect sympathetic activation during sleep. We assessed the relationship between nocturnal PWA attenuation and office blood pressure (BP).

Methods: Eighty-one subjects (46 men; age 60+/-7 years; body mass index [BMI] 28.2+/-4.3 kg/m(2); apnea hypopnea index [AHI], 25.4+/-22.6 events/h; systolic BP 137+/-15 mm Hg; diastolic BP 79+/-7 mm Hg) recruited from a population based cohort underwent simultaneous ambulatory polysomnography (PSG) and peripheral arterial tonometry (PAT) recording. Episodic attenuations of PWA derived from the pulse waveform of the PAT signal were identified and characterized. Generalized least squares regression models were used to identify the associations between median PWA attenuation (PWA.att), office BP and sleep-related disordered breathing.

Results: We found that the association between PWA.att and office BP was independent of gender, age, BMI, antihypertensive medication, number of attenuation episodes, AHI, oxygen desaturation 4% index (ODI4) and arousal index. Each 10% increase in PWA.att was associated with increases of 5.0 mm Hg systolic BP (P=0.02) and 3.0 mm Hg diastolic BP (P=0.005). We also found independent relationships between systolic/diastolic BP and BMI (P=0.0006/0.001), AHI (P=0.03/0.1) and ODI4 (P=0.03/0.03).

Conclusions: The degree of PWA attenuation during the night is associated with office BP independent of sleep-disordered breathing. Continuous assessment of PWA during sleep may provide novel insights into cardiovascular physiology and morbidity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure / physiology*
  • Circadian Rhythm / physiology*
  • Cohort Studies
  • Female
  • Heart Rate / physiology
  • Humans
  • Hypertension / physiopathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Physicians' Offices
  • Polysomnography
  • Pulsatile Flow / physiology*
  • Regression Analysis
  • Sleep Apnea Syndromes / physiopathology
  • Sympathetic Nervous System / physiology*