Abstract
The aim is to investigate the association between alterations in the serum potassium (K+) concentration and sleep architecture parameters in essential hypertensives. Two hundred ninety-two hypertensives undergoing polysomnography and providing blood samples were recruited. The sleep architecture was composed of sleep stages 1 (N1), 2 (N2), 3 (N3), 4 (N4) and REM. The light sleep stage (LST) was composed of N1 + N2, and the deep sleep stage (DST) was composed of N3 + N4. The potentialrelationships between electrolytes and sleep parameters were determined via univariate and multivariate analyses. The subjects were divided into two groups via the serum K+ median (3.86 mmol/L). The K+ < 3.86 mmol/L group showed significantly decreased N1 (7.10 ± 4.55% vs 8.61 ± 5.23%, p = 0.002), LST (71.48 ± 11.33% vs 75.92 ± 17.08%, p = 0.013), and periodic leg movement during sleep related to microarousals (MA) /arousal (PLMS-A) [4 (1~10) vs 8 (3~15)/night, p < 0.001] and increased REM (17.38 ± 6.43% vs 15.37 ± 6.18%, p = 0.007) compared to the K+ ≥ 3.86 mmol/L group. A subdivided analysis by gender showed that these changes were more statistically significant in men than in women. Significant positive correlations were identified between K+ and N1 (r = 0.169, p = 0.004), as well as PLMS-A (r = 0.222, p < 0.001) in subjects. Compared to women, a significantly strong correlation was identified between K+ and REM sleep in men (r = 0.158, p = 0.028 vs. r = 0.078, p = 0.442). Multiple linear regression analysis indicated that K+ is significantly associated with N1 in all subjects (p = 0.03) and with REM in men (p = 0.008), even after adjusting for confounders. Decreased K+ may disturb the homeostasis of the sleep architecture, and gender may interfere with their links in the hypertensive population.
Highlights
Sleep accounts for approximately one third of the human lifetime, a complex phenomenon that comprises two substrates, non–rapid and rapid eye movement sleep (NREM and REM)
The demographic and polysomnographic characteristics of the subjects in the two groups are shown in Table 1. ubjects in the two groups showed no significant difference in gender composition, age (45.20 ± 9.88 years vs. 44.93 ± 8.84 years, p = 0.807), body mass index (BMI), Na +, Cl, Ca2+, Mg2+, total CO2, fasting glucose, 24 h urinary creatinine and uric acid, urinary pH, and systolic and diastolic blood pressure
0.03) and with REM in men (p = 0.008), even after adjusting for age, BMI, apnea-hypopnea index (AHI), SBP, DBP, Na+, Cl, Ca2+, Mg2+ and fasting glucose with/without smoking history as potential confounders. This investigation is the first study to propose circulating K + concentrations may disturb the sleep pattern assessed by PSG in essential hypertension
Summary
Sleep accounts for approximately one third of the human lifetime, a complex phenomenon that comprises two substrates, non–rapid and rapid eye movement sleep (NREM and REM). NREM is further divided into stages, such as N1, N2, N3 and N4; the latter two stages are referred to. These authors contributed : Mulalibieke Heizhati, Yu Zhang. There has recently been increasing interest in the homeostasis of sleep patterns. The sleep architecture might be influenced by various factors, including external factors, such as environmental factors, and internal factors, such as gender, age, menstrual cycle, exercise [7,8,9,10,11] andphysical diseases. The sleep-wake cycle and sleep architecture, the REM-sleep homeostasis, might be influenced by neuronal potassium conductance [12, 13]. It has been demonstrated that following a reduction of K+ levels, the cell surface density of potassium
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