The association between ambulatory blood pressure rhythm and urinary albumin excretion rate in type 2 diabetes with sleep disorder patients

Abstract

Objective To investigate the association between ambulatory blood pressure rhythm and urinary albumin excretion rate (UAER) in type 2 diabetes with sleep disorder patients. Methods Three hundred and seventy three in–patients with type 2 diabetes treated from May 2012 to May 2014 in Metabolic Disease Hospital of Tianjin Medical Universitywere divided into two groups according to Pittsburgh Sleep Quality Index(PSQI): patients without sleep disorder (267) and patients with sleep disorder (106). The groups were further divided into normoalbuminuria group, microalbuminuria group and macroalbuminuria group by UAER. The changes of the average blood pressure, the circadian rhythm of blood pressure, the smoothness index of blood pressure and blood pressure variation were analyzed between the two groups and each subgroup. The regression analysis were performed between sleep disorder as well as UAER and other indicators. One–way ANOVA was used to analyze data among multiple groups. LSD-t test was used to analyze data between two groups. Results (1) The average blood pressure as well as coefficient variations of blood pressure was significant higher and the decreasing percentage of blood pressure at night and smoothness index of blood pressure was significant lower in patients with sleep disorder than those in patients without sleep disorder(t=2.9924- 5.3979, all P<0.05). (2) The average blood pressure and coefficient variation of blood pressure increased and the decreasing percentage of blood pressure at night and smoothness index of blood pressure decreased in all with and without sleep disorder subgroup patients with the increasing UAER. Significant changes of the above indicators were in sleep disorder subgroup(t=2.0073-4.0395, all P<0.05). (3) sleep disorder was positively related to 24 h systolic blood pressure, systolic blood pressure at night and UAER,whereas was negatively related to the decreasing percentage of systolic blood pressure at night(Wald= 4.192,4.590,6.019,5.910, all P<0.05).UAER was positively related to PSQI score, diastolic blood pressure at night and systolic blood pressure at night, whereas was negatively related to the decreasing percentage of systolic blood pressure at night(β=0.224, 0.251, 0.287, – 0.242, all P<0.05). Conclusion Abnormal circadian rhythm of blood pressure in type 2 diabetes patients with sleep disorder may be related to UAER. Key words: Diabetes mellitus, type 2; Sleep disorder; Ambulatory blood pressure; Circadian rhythm; Urinary albumin excretion rate