中国高血压防治指南(2018年修订版)

  目的   探讨江苏省南京市成年高血压患者夜间睡眠时间与血压控制之间的关系，为高血压的预防与控制提供参考依据。  方法   于2017年 1 月 — 2018 年 6 月采用多阶段分层整群随机抽样方法在江苏省南京市抽取 61 098 名成年居民进行慢性病及其危险因素监测，最终纳入其中15 686例高血压患者采用多因素非条件logistic回归模型分析其夜间睡眠时间与血压控制的关系。  结果   南京市15 686例成年高血压患者中，血压控制者7 082例，血压控制率为45.1%；夜间睡眠时间 < 6、6～、7～、8～和 ≥ 9 h/d成年高血压患者的血压控制率分别为43.8%、45.6%、47.2%、43.7%和40.2%，不同夜间睡眠时间高血压患者血压控制率差异有统计学意义（χ² = 23.354，P < 0.001）。在控制了性别、年龄、居住地、文化程度、是否现在吸烟、是否有害饮酒、是否身体活动不足、是否使用降压药、是否糖尿病、是否血脂异常和体质指数等混杂因素后，多因素非条件logistic回归分析结果显示，南京市夜间睡眠时间 < 6 h/d和 ≥ 9 h/d成年高血压患者血压控制可能性分别为夜间睡眠时间7 h/d～成年高血压患者的0.88倍（OR = 0.88，95%CI = 0.77～0.99）和0.75倍（OR = 0.75，95%CI = 0.65～0.87）。分层分析结果显示，在控制了年龄、居住地、文化程度、是否现在吸烟、是否有害饮酒、是否身体活动不足、是否使用降压药、是否糖尿病、是否血脂异常和体质指数等混杂因素后，男性夜间睡眠时间 < 6 h/d、8 h/d～和 ≥ 9 h/d成年高血压患者血压控制可能性分别为夜间睡眠时间7 h/d～成年高血压患者的0.74倍（OR = 0.74，95%CI = 0.62～0.89）、0.86倍（OR = 0.86，95%CI = 0.76～0.95）和0.75倍（OR = 0.75，95%CI= 0.62～0.92），女性夜间睡眠时间 ≥ 9 h/d成年高血压患者血压控制可能性为夜间睡眠时间7 h/d～成年高血压患者的0.73倍（OR = 0.73，95%CI = 0.59～0.91）；在控制了性别、居住地、文化程度、是否现在吸烟、是否有害饮酒、是否身体活动不足、是否使用降压药、是否糖尿病、是否血脂异常和体质指数等混杂因素后， ≥ 60岁夜间睡眠时间 < 6 h/d和 ≥ 9 h/d成年高血压患者血压控制可能性分别为夜间睡眠时间7 h/d～成年高血压患者的0.80倍（OR = 0.80，95%CI = 0.68～0.94）和0.68倍（OR = 0.68，95%CI = 0.56～0.83）。  结论   夜间睡眠时间过短或过长均会降低南京市成年高血压患者的血压控制率，尤其在男性和 ≥ 60岁高血压患者中更为明显。

A systematic review of sleep,hypertension, and cardiovascular risk in children and adolescents

  Objective   To investigate the relationship between sleep duration and blood pressure control among community adult hypertension patients for providing evidence to blood pressure control in the population.   Methods   The participants of the study were 15 686 hypertension patients identified from 61 098 adult residents (aged ≥ 18 years) recruited with stratified multi-stage cluster sampling for the Nanjing Chronic Disease and Risk Factor Surveillance in communities of 5 districts of Nanjing city. Face-to-face interview with a self-designed questionnaire and International Physical Activity Questionnaire (IPAQ), physical examination and laboratory tests were conducted among all the residents during January 2017 – June 2018. Multiple logistic regression model was used to analyze the association of sleep duration with blood pressure control of the hypertension patients.   Results   Of all the hypertension patients, 45.1% (7 082) were assessed as having effective blood pressure control (systolic blood pressure <140 mm Hg and/or diastolic pressure <90 mm Hg) and the proportions of effective blood pressure control were 43.8%, 45.6%, 47.2%, 43.7%, and 40.2% for the patients reporting the night sleep duration of < 6.0 , 6.0 – 6.9 , 7.0 – 7.9 , 8.0 – 8.9, and ≥ 9.0 hours per day (h/d), respectively, with a significant difference (χ² = 23.354, P < 0.001). After adjusting for gender, age, residential area, education, smoking, alcohol consumption, physical activity, body mass index, diabetes, dyslipidemia, and anti-hypertensive medication, the results of multivariate logistic regression analysis for all hypertension patients revealed that compared to the patients with the sleep duration of 7.0 – 7.9 h/d, those with a shorter or longer sleep duration were less likely to have an effective blood pressure control (for sleep duration of < 6 h/d: odds ratio [OR] = 0.88, 95% confidence interval [95%CI]: 0.77 – 0.99; for sleep duration of ≥ 9 h/d: OR = 0.75, 95%CI: 0.65 – 0.87); further analysis using the comparison groups with the sleep duration of 7.0 – 7.9 h/d also showed that some subgroups with a shorter or longer sleep duration were also less likely to have an effective blood pressure control: (1) the male patients with the sleep duration of < 6 h/d (OR = 0.74, 95%CI: 0.62 – 0.89), 8.0 – 8.9 h/d (OR = 0.86, 95%CI: 0.76 – 0.95) or ≥ 9 h/d (OR = 0.75, 95%CI: 0.65 – 0.87); (2) the female patients with sleep duration of ≥ 9 h/d (OR = 0.73 95%CI: 0.59 – 0.91); (3) the elderly patients (aged ≥ 60 years) with the sleep duration of < 6 h/d (OR = 0.80, 95%CI: 0.68 – 0.94) or ≥ 9 h/d (OR = 0.68, 95%CI: 0.56 – 0.83).   Conclusion   The study results suggest that night sleep duration is associated with effective blood pressure control among community adult hypertension patients, especially among those being male and those aged 60 years and above.