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How Is Slow Wave Sleep Related to Hypertension?

2011; Lippincott Williams & Wilkins; Volume: 59; Issue: 2 Linguagem: Inglês

10.1161/hypertensionaha.111.184895

1524-4563

Mark R. Pressman,

Sleep and related disorders

HomeHypertensionVol. 59, No. 2How Is Slow Wave Sleep Related to Hypertension? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBHow Is Slow Wave Sleep Related to Hypertension? Mark R. Pressman Mark R. PressmanMark R. Pressman Originally published12 Dec 2011https://doi.org/10.1161/HYPERTENSIONAHA.111.184895Hypertension. 2012;59:e10Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 To the Editor:I recently read with interest the article by Fung et al.1 I note that in the online Data Supplement (available at http://hyper.ahajournals.org) to this article that it is reported that, among the parameters measured, was bilateral leg movements. However, data regarding periodic leg movements in sleep (PLMS) was not reported. PLMS are among the most common sleep disorders in the age group (>65 years) studied in this article. PLMS occur most prominently during the first third of the sleep period. The first third of the sleep period generally includes the majority of slow-wave sleep (SWS). PLMS may disrupt sleep and SWS by producing brief arousals. As PLMS increase with age, SWS decreases.2From a sleep analysis point of view, it may be argued that effects of any PLMS were included in the analysis, because arousals from all sources were apparently scored. However, PLMS have also been associated with so-called "autonomic arousals" that are not easily scored visually.3 These autonomic arousals are associated with brief increases in both heart rate and blood pressure. However, the effect of PLMS on these cardiovascular parameters are unknown.4 For these reasons, the total number of PLMS or the PLMS index might provide an additional parameter to be considered or may well indeed be related to SWS reduction. Can the reader look forward to a further analysis of the data with PLMS as a factor?In addition, the data on sleep disordered breathing do not break down the respiratory disturbance index between rapid eye movement (REM) and non-REM sleep. This also appears to be a potential confounding variable that might have reduced the significance of the author's finding. Subjects whose sleep-disordered breathing is primarily confined to REM sleep would seem more likely to have less interrupted non-REM sleep and thus more SWS. The presence of a high respiratory disturbance index (in REM) and high SWS would certainly act to reduce the significance of the findings.I am not convinced by these data that the reduction of SWS, in and of itself, is somehow related to hypertension. SWS can be reduced or completely eliminated by benzodiazepines and other sedative/hypnotics. Yet, I am not aware that the absence of SWS in this massive population of patients results in hypertension. A significant reduction or elimination of SWS can also occur secondary to many forms of sleep-fragmenting disorders, including sleep apnea and PLMS, or could result from normal aging of the brain. It would appear reasonable that the source of the SWS reduction is most likely associated with hypertension.Mark R. Pressman Sleep Medicine Services Lankenau Medical Center and Lankenau Institute for Medical Research Wynnewood, PA Department of Medicine Jefferson Medical College Philadelphia, PADisclosuresNone.FootnotesLetters to the Editor will be published, if suitable, as space permits. They should not exceed 1000 words (typed double-spaced) in length and may be subject to editing or abridgment.References1. Fung MM, Peters K, Redline S, Ziegler MG, Ancoli-Israel S, Barrett-Connor Elizabeth, Stone KL. Osteoporotic Fractures in Men Research Group. Decreased slow wave sleep increases risk of developing hypertension in elderly men. Hypertension. 2011; 58:596–603.LinkGoogle Scholar2. Ferri R, Manconi M, Lanuzza B, Cosentino FII, Bruni O, Ferini-Strambi L, Zucconi M. Age-related changes in in periodic leg movements during sleep in patients with restless legs syndrome. Sleep Med. 2008; 9:790–798.CrossrefMedlineGoogle Scholar3. Yang CK, Jordan AS, White DP, Winkelman J. Heart rate response to respiratory events with or without leg movements. Sleep. 2006; 29:553–556.CrossrefMedlineGoogle Scholar4. Siddiqui F, Strus J, Ming X, Lee IA, Chokroverty S, Walters AS. Rise of blood pressure with periodic limb movements in sleep and wakefulness. Clin Neurophysiol. 2007; 118:1923–1930.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Li P, Guo W, Du L, Zhao J, Wang Y, Liu L, Hu Y and Hou Y (2012) microRNA-29b contributes to pre-eclampsia through its effects on apoptosis, invasion and angiogenesis of trophoblast cells, Clinical Science, 10.1042/CS20120121, 124:1, (27-40), Online publication date: 1-Jan-2013. Redline S, Peters K, Fung M, Ziegler M, Ancoli-Israel S, Barrett-Connor E and Stone K (2011) Response to How Is Slow Wave Sleep Related to Hypertension?, Hypertension, 59:2, (e11-e11), Online publication date: 1-Feb-2012. February 2012Vol 59, Issue 2 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.111.184895PMID: 22158641 Originally publishedDecember 12, 2011 PDF download Advertisement SubjectsClinical StudiesHypertension