Sleep Duration, Kidney Function, and Their Effects on Cerebral Small Vessel Disease in Elderly Hypertensive Patients

Am J Hypertens. 2015 Jul;28(7):884-93. doi: 10.1093/ajh/hpu243. Epub 2015 Jan 5.


Background: Short sleep duration has been shown to be associated with cardio/cerebrovascular disease. White matter hyperintensities (WMH) have been associated with an increased risk of stroke. In addition to high ambulatory blood pressure (BP), chronic kidney disease (CKD) is a risk for WMH. In this study, we investigated the relationships among sleep duration, CKD, and WMH in elderly hypertensives.

Methods: Ambulatory BP monitoring and brain magnetic resonance imaging were performed in 514 Japanese elderly hypertensives (mean age 72.3 years, males 37%). WMH cases were further divided into deep subcortical white matter lesion or periventricular hyperintensity (PVH). CKD (n = 193) was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m(2).

Results: According to sleep duration (<7.5, ≥7.5 to <9.5, and ≥9.5 hour per night), significant associations of sleep duration were observed with WMH and PVH. In the regression analysis including age, gender, smoking, antiplatelet agents use, 24-hour systolic BP, nondipper, white coat hypertension and CKD, short sleep duration was significantly positively associated with WMH and PVH when subjects with mid-range sleep duration were used as a reference group. A significant interaction was found between short sleep duration and CKD for PVH. In the non-CKD group, short sleep duration had strong significant positive associations with WMH and PVH.

Conclusions: In the present study, short sleep duration was a positive significant determinant for WMH and PVH in elderly hypertensives. Sleep duration might serve as a strong determinant for white matter lesions especially in those without CKD.

Keywords: blood pressure; cerebral small vessel disease; hypertension; kidney function; sleep duration; white matter hyperintensity..

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory
  • Cerebral Small Vessel Diseases / diagnosis
  • Cerebral Small Vessel Diseases / etiology*
  • Cerebral Small Vessel Diseases / physiopathology
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hypertension / complications*
  • Hypertension / diagnosis
  • Hypertension / physiopathology
  • Japan
  • Kidney / physiopathology*
  • Leukoencephalopathies / complications
  • Leukoencephalopathies / diagnosis
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors
  • Sleep*
  • Time Factors