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Nocturia and increase in nocturnal blood pressure

the Nagahama study

Matsumoto, Takeshia; Tabara, Yasuharub; Murase, Kimihikoc; Setoh, Kazuyab; Kawaguchi, Takahisab; Nagashima, Shunsuked; Kosugi, Shinjie; Nakayama, Takeof; Wakamura, Tomokod; Hirai, Toyohiroa; Matsuda, Fumihikob; Chin, Kazuoc the Nagahama study group

doi: 10.1097/HJH.0000000000001802
ORIGINAL PAPERS: Blood pressure measurements

Objective: Abnormalities in circadian blood pressure (BP) variation, particularly increase in nocturnal BP, have been reported to be risk factors for cardiovascular disease, although the factors associated with BP abnormalities are not fully understood. This study aimed to clarify possible associations of sleep characteristics, including sleep fragmentation, sleep disordered breathing, and nocturia, with sleep BP by simultaneous multiday measurements.

Methods: A cross-sectional study evaluated 5959 community participants having home-measured data on nocturnal BP change (sleep BP − awaking BP), sleep characteristics, and sleep disordered breathing. Sleep characteristics including the fragmentation index were assessed using wrist-wearable actigraphy, whereas sleep disordered breathing was assessed by 3% oxygen desaturation index obtained using a finger-type monitor. The number of nocturnal urinations was recorded in a sleep diary.

Results: Mean nocturnal SBP change was −8.5 ± 7.9%. A 3% oxygen desaturation index was associated with the BP change independently of the basic covariates (β = 0.051, P = 0.001), although the association became insignificant (P = 0.196) after adjusting the fragmentation index (β = 0.105, P < 0.001). The association of the fragmentation index was also insignificant (P = 0.153) after adjusting measurement season (middle season: β = 0.163, P < 0.001; summer season: β = 0.249, P < 0.001). In contrast, the frequency of urination showed strong and independent association (β = 0.140, P < 0.001), with smaller nocturnal BP drop in participants with frequent urination.

Conclusion: Subjective sleep estimates and frequent nocturnal urination may represent a potential risk for circadian BP abnormalities.

aDepartment of Respiratory Medicine

bCenter for Genomic Medicine

cDepartment of Respiratory Care and Sleep Control Medicine

dDepartment of Human Health Science

eDepartment of Medical Ethics and Medical Genetics

fDepartment of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan

Correspondence to Yasuharu Tabara, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Shogoinkawara-cho 53, Sakyo-ku, Kyoto 606-8507, Japan. Tel: +81 75 751 4157, fax: +81 75 751 4167, e-mail:

Received 9 April, 2018

Accepted 23 April, 2018

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