Abstract
BackgroundAntihypertensive medication use and sleep problems are highly prevalent in nursing home patients. While it is hypothesized that blood pressure and antihypertensive medication use can affect sleep, this has not been investigated in depth in this population. Alongside a multicomponent intervention including a systematic medication review, we aimed to investigate the longitudinal association between antihypertensive medication use, blood pressure and day- and night-time sleep over 4 months.MethodsThis study was based on secondary analyses from the multicomponent cluster randomized controlled COSMOS trial, in which the acronym denotes the intervention: COmmuncation, Systematic pain assessment and treatment, Medication review, Organization of activities and Safety. We included baseline and 4-month follow-up data from a subgroup of nursing home patients who wore actigraphs (n = 107). The subgroup had different levels of blood pressure, from low (< 120) to high (≥ 141). Assessments included blood pressure, antihypertensive medication use, and sleep parameters as assessed by actigraphy.ResultsWe found a significant reduction in total sleep time at month four in the intervention group compared to the control group. When analysing the control group alone, we found a significant association between antihypertensive medication use and increased daytime sleep. We also found negative associations between blood pressure, antihypertensive medication use and sleep onset latency in the control group.ConclusionsOur results suggest a correlation between excessive daytime sleep and antihypertensive medication use. These findings should be followed up with further research, and with clinical caution, as antihypertensive medications are frequently used in nursing homes, and sleep problems may be especially detrimental for this population.Trial registrationThe trial is registered at clinicaltrials.gov (NCT02238652).
Highlights
Antihypertensive medication use and sleep problems are highly prevalent in nursing home patients
11 patients in the intervention group and 5 in the control group had quitted using antihypertensive medications, while only one patient had started using these medications. Looking at both groups combined at baseline, we found no significant associations between sleep parameters and blood pressure or antihypertensive medication use (Table 2, systolic data shown)
Looking at the observational follow-up data in the control group, we found a significant association between increased systolic blood pressure and increased total sleep time from baseline to month 4 (MC 25.0 min, Confidence Interval (CI) = 4.5–45.5, p < 0.05) (Table 4)
Summary
Antihypertensive medication use and sleep problems are highly prevalent in nursing home patients. Increased daytime sleep may be considered an adaptive response to impaired night-time sleep, it is well-known that naps negatively impacts sleep at night [1]. This pattern of daytime sleep and nighttime wake-periods is common in nursing home patients and in people with dementia [4]. There is inconclusive research regarding the potential benefits or unwanted side effects and risks of antihypertensive medication use in nursing home patients and people with dementia [6]. Antihypertensive treatment is associated with orthostatic hypotension, falls, and increased anticholinergic burden [11]
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