Nighttime Home Research Articles

SEASONAL VARIATION OF NIGHTIME HOME BLOOD PRESSURE AND ITS ASSOCIATION WITH TARGET ORGAN DAMAGE: THE J-HOP NOCTURNAL BLOOD PRESSURE STUDY

Objective: Although seasonal variation of nighttime home blood pressure (BP) was reported as higher in summer than winter, seasonal differences in the association of nighttime home BP with target organ damage (TOD) remains unclear. Hence, we assessed the seasonal variation of nighttime home BP and its association with TOD using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study. Design and method: This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with a history of or risk factors of cardiovascular disease. Participants underwent consecutive 14-day home BP measurements (morning and evening) and nighttime home BP measurements (a.m. 2, 3, and 4). Urine albumin creatinine ratio (UACR) and serum-brain natriuretic peptide (BNP) were collected at enrollment. Results: Among 2545 participants (age, 63.3 ± 10.3 yrs; antihypertensive medication use 82.6%), 629, 596, 719, and 601 participants were enrolled in spring, summer, autumn, and winter, respectively. Nighttime home systolic/diastolic BP (SBP/DBP) were higher in summer than in winter (SBP/DBP in summer, 123.3 ± 14.6/70.4 ± 8.9 mmHg; vs. in winter, 119.3 ± 14.0/69.1 ± 8.4 mmHg, each p value < 0.05 after adjusted with Bonferroni collection in each season), and the prevalence of riser pattern was also higher in summer than in winter (in summer, 27.2%; vs. in winter, 10.1%, p < 0.05). When the interaction between BP parameters and each season for the association with TOD was assessed, an association between riser pattern and UACR and an association between nighttime home DBP and BNP were stronger in winter compared to those in other seasons (both p for interaction < 0.05). Conclusions: In the present study, we revealed the association of nighttime home BP and TOD was stronger in winter than in other seasons.

SEASONAL VARIATION OF MASKED UNCONTROLLED NOCTURNAL HYPERTENSION MEASURED BY NIGHTIME HOME BLOOD PRESSURE: THE J-HOP NOCTURNAL BLOOD PRESSURE STUDY

Objective: Usual daytime (morning and evening) home blood pressure (BP) monitoring can not detect nighttime hypertension. Masked uncontrolled nocturnal hypertension is defined as uncontrolled nighttime BP nonetheless controlled usual daytime home BP (HBP). Although previous studies have reported seasonal variation of nighttime BP evaluated by ambulatory BP monitoring is higher in summer than winter, seasonal variation in prevalence of masked uncontrolled nocturnal hypertension evaluated by nighttime HBP measurements remains unclear. Hence, we assessed the seasonal variation in nighttime HBP and the prevalence of masked uncontrolled nocturnal hypertension using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study. Design and method: This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with a history of or risk factors of cardiovascular disease. Participants underwent consecutive 14-day HBP measurements (morning and evening) and nighttime HBP measurements (a.m. 2, 3, and 4). We divided participants into four groups in each season. Masked uncontrolled nocturnal hypertension was defined as controlled daytime HBP (mean of morning and evening home systolic BP [SBP] < 135 mmHg and diastolic BP [DBP] < 85 mmHg) and uncontrolled nocturnal HBP (mean nighttime home SBP >= 120 or DBP >= 70 mmHg). Results: Among 2545 participants (age, 63.3 ± 10.3 yrs; 49% of male; antihypertensive medication use, 82.6%), 629, 596, 719, and 601 participants were enrolled in spring, summer, autumn, and winter, respectively. Nighttime home SBP/DBP were higher in summer than winter (SBP/DBP in summer, 123.3 ± 14.6/70.4 ± 8.9 mmHg; vs. in winter, 119.3 ± 14.0/69.1 ± 8.4 mmHg, p < 0.05). In 1490 participants with controlled daytime HBP, moreover, the prevalence of masked uncontrolled nocturnal hypertension was higher in summer than other seasons (summer, 55.7% vs. spring, 41.8%; vs. autumn, 42.9%; vs. winter, 39.7%, all p < 0.01). These relationships were also observed in multivariate logistic regression analysis (Table). Conclusions: In the present study, we revealed the prevalence of masked uncontrolled nocturnal hypertension was higher in summer than other seasons.

DIRECT COMPARISON OF HOME VERSUS AMBULATORY DEFINED NOCTURNAL HYPERTENSION FOR PREDICTING CARDIOVASCULAR EVENTS: THE J-HOP STUDY

Objective: The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring night-time blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events. Design and method: We analyzed night-time blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. Results: During a follow-up period of 7.6 ± 3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive and 80.7% participants were using antihypertensive medication. Night-time home systolic blood pressure (SBP) was higher compared to night-time ambulatory SBP (123.0 ± 14.6 versus 120.3 ± 14.4, p < 0.001). Nocturnal hypertension was defined as night-time home or ambulatory SBP of 120 mmHg or more. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events; total cardiovascular events (coronary artery disease and stroke events) [1.83 (1.00; 3.37)] and stroke [2.87 (1.17; 7.03)], independent of office SBP and night-time ambulatory SBP. These results were absent with nocturnal hypertension defined by ABPM. Conclusions: This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP and night-time ambulatory SBP) is a predictor of future cardiovascular events.

CLINICAL CHARACTERISTICS IN THE PATIENTS WITH MASKED UNCONTROLLED NOCTURNAL HYPERTENSION MEASURED BY NIGHTTIME HOME BLOOD PRESSURE MONITORING: THE J-HOP NOCTURNAL BLOOD PRESSURE ST

Objective: Various international guidelines on the management of hypertension recommend nighttime blood pressure (BP) measurements in specific conditions such as sleep apnea, secondary hypertension, etc. However, we physicians sometimes miss nocturnal hypertension in patients with controlled daytime (morning and evening) home BP (HBP), i.e. “masked uncontrolled nocturnal hypertension”. Risk factors of masked uncontrolled nocturnal hypertension remain unclear in clinical practice and we thus assessed that using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study. Design and method: This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with risk factors of CVD. Participants underwent consecutive 14-day HBP measurements (morning and evening) and nighttime HBP measurements (a.m. 2, 3, and 4). In the present study, masked uncontrolled nocturnal hypertension was defined as controlled daytime HBP (mean of morning and evening home systolic BP [SBP] < 135 mmHg and diastolic BP [DBP] < 85 mmHg) and uncontrolled nighttime HBP (mean nighttime home SBP > = 120 or DBP > = 70 mmHg). To detect the risk factors of masked uncontrolled nocturnal hypertension, we used traditional host factors, using each type of antihypertensive medications, and markers of target organ damage (urine-albumin creatinine ratio [UACR] and b-type Natriuretic peptide) as covariant in stepwise logistic regression models. Results: Among 1490 participants with controlled daytime HBP levels (age, 62.5 ± 9.7yrs; 49% of male; antihypertensive medication use, 82.2%), male, diabetes, elevated office BP, and log-UACR were significant risk factors for masked uncontrolled nocturnal hypertension in multivariate logistic regression models (OR [95%CI]: male, 1.42 [1.11–1.82]; diabetes, 1.41 [1.09–1.83]; elevated office BP, 1.72 [1.38–2.14]; log-UACR, 1.35 [1.06–1.71]) (Table). Whereas, combination therapy of more than three antihypertensives including diuretics showed a lower odds ratio (0.56 [0.40–0.78]). Conclusions: In the present study, we revealed that male, diabetes, elevated office BP, and highly log-UACR were suggested to be risks for masked uncontrolled nocturnal hypertension. A nighttime HBP monitoring might be recommended for patients who have these risks even if they are controlled daytime HBP levels.

Comparison of nighttime measurement schedules using a wrist-type nocturnal home blood pressure monitoring device.

We investigated the optimal nighttime home blood pressure (BP) measurement schedule for wrist BP monitoring. Fifty hypertensive patients (mean age 68.9 ± 11.3 years) self‐measured their nighttime BP hourly using a wrist‐type nocturnal home BP monitoring device at home on two consecutive nights. Using the average 7.2 ± 1.5 measurements per night, we compared the clock‐based index (average of three measurements at 2:00, 3:00, and 4:00 a.m.) and the bedtime‐based index (average of three measurements at 2, 3, and 4 h after bedtime). The clock‐based average was significantly higher than the bedtime‐based average for both systolic BP (2.7 ± 8.2 mmHg, P = .002) and diastolic BP (1.9 ± 5.1 mmHg, P < .001). Compared to the average of all measurements throughout a night (the same definition of ambulatory BP monitoring, ie, from the time point of going to bed to awakening), the clock‐based average was comparable (systolic/diastolic BP: −0.5 ± 5.5/−0.2 ± 3.7), whereas the bedtime‐based average was significantly lower (−3.3 ± 5.0/−2.1 ± 3.6). Thus, the repeated measurement of wrist‐measured nighttime BP at three clock‐based time points per night provided reliable values. Further prospective studies of larger populations are required to confirm the optimal nighttime BP measurement schedule for wrist BP monitoring for the prediction of cardiovascular events.

Sleep-Disordered Breathing in Pregnancy.

Sleep-disordered breathing (SDB) is a spectrum of abnormal respiratory events including habitual snoring and increased upper airway resistance and obstructive episodes. The uncertainties concerning the incidence and recognition of SDB during pregnancy and the importance of the issue for fetal and maternal health prompted us to screen pregnant women for SDB. The study included 312 women in the third trimester of pregnancy aged 17-46 of whom 51 were preselected, based on the results of SDB questionnaires, for a nighttime home screening using a portable ApneaLink Air device. We found that single or multiple episodes of apnea were present in 35 (69%) women. The mean apnea/hypopnea index (AHI) was 1.8±1.8 episodes/h of sleep, which did not exceed the prevalence in the general young-adult female population. However, we noticed a substantial number of inspiratory airflow limitation (IFL) episodes most often accompanied by snoring and more frequent in pregnant women with a greater weight gain. IFLs, although not fulfilling the quantifiable criteria of hypopnea, raise the possibility of hardly recognizable oxygenation and cardiovascular disturbances in pregnancy, reflected in an increased risk index for SDB. We conclude that pregnancy encompasses the risk of revealing or intensifying pre-existing SDB which can jeopardize maternal and fetal health. The risk particularly applies to overweight women. We submit that women in late pregnancy should be carefully screened for possible SDB.

Seasonal Variation in Masked Nocturnal Hypertension: The J-HOP Nocturnal Blood Pressure Study.

Little is known about seasonal variation in nighttime blood pressure (BP) measured by a home device. In this cross-sectional study, we sought to assess seasonal variation in nighttime home BP using data from the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. In this study, 2,544 outpatients (mean age 63 years; hypertensives 92%) with cardiovascular risks underwent morning, evening, and nighttime home BP measurements (measured at 2:00, 3:00, and 4:00 am) using validated, automatic, and oscillometric home BP devices. Our analysis showed that nighttime home systolic BP (SBP) was higher in summer than in other seasons (summer, 123.3 ± 14.6 mmHg vs. spring, 120.7 ± 14.8 mmHg; autumn, 121.1 ± 14.8 mmHg; winter, 119.3 ± 14.0 mmHg; all P<0.05). Moreover, we assessed seasonal variation in the prevalence of elevated nighttime home SBP (≥120 mmHg) in patients with non-elevated daytime home SBP (average of morning and evening home SBP <135 mmHg; n = 1,565), i.e., masked nocturnal hypertension, which was highest in summer (summer, 45.6% vs. spring, 27.2%; autumn, 28.8%; winter, 24.9%; all P<0.05). Even in intensively controlled morning home SBP (<125 mmHg), the prevalence of masked nocturnal hypertension was higher in summer (summer, 27.4% vs. spring, 14.2%; autumn, 8.9%; winter, 9.0%; all P<0.05). The urine albumin-creatinine ratio in patients with masked nocturnal hypertension tended to be higher than that in patients with non-elevated both daytime and nighttime SBP throughout each season. The prevalence of masked nocturnal hypertension was higher in summer than other seasons and the difference proved to be clinically meaningful.

Nighttime Blood Pressure Measured by Home Blood Pressure Monitoring as an Independent Predictor of Cardiovascular Events in General Practice.

We developed an innovative automated home blood pressure (BP) monitoring method that measures BP while asleep repeatedly over several days. Our aim was to assess the predictive ability of nighttime BP obtained using the home BP device for incident cardiovascular disease (CVD) in general practice patients. We used data from the nationwide practice-based J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP Study, which recruited 2545 Japanese with a history of or risk factors for CVD (mean age 63 years; antihypertensive medication use 83%). The associations between nighttime home BPs (measured at 2:00, 3:00, and 4:00 am using validated, automatic, and oscillometric home BP devices) and incident CVD, including coronary disease and stroke events, were assessed with Cox proportional hazards models. The mean±SD office, morning home, and nighttime home systolic BP (SBP)/diastolic BP were 140±15/82±10, 137±15/79±10, and 121±15/70±9 mm Hg, respectively. During a follow-up of 7.1±3.8 years (18,116 person-years), 152 CVD events occurred. A 10-mm Hg increase of nighttime home SBP was associated with an increased risk of CVD events (hazard ratios [95% CIs]: 1.201 [1.046-1.378]), after adjustments for covariates including office and morning home SBPs. The model fit assessed by the change in Goodness-of-Fit was improved when we added nighttime home SBP into the base models including office and morning home SBPs (Δ6.838 [5.6%]; P=0.009). This is among the first and largest nationwide practice-based study demonstrating that nighttime SBP obtained using a home device is a predictor of incident CVD events, independent of in-office and morning in-home SBP measurement. Clinical Trial Registration- URL: http://www.umin.ac.jp/icdr/index.html . Unique identifier: UMIN000000894.

Nocturnal Hypertension: New Technology and Evidence.

The issues of hypertension paradox—more uncontrolled disease despite improved therapy—have received increased attention in the era of strict blood pressure (BP) control after SPRINT (Systolic Blood Pressure Intervention Trial) in 2015.1 The new direction in the management of hypertension is to pursue earlier and lower BP control throughout 24 hours.2 The new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines propose that all the BPs measured during the awake period (clinic BP and home BP measured in the morning and evening) and daytime ambulatory BPs should be controlled to <130/80 mm Hg as a universal BP goal.3 Even if the clinic BP is well-controlled, masked morning and daytime hypertension (uncontrolled daytime and morning or evening home BPs) pose an increased risk of cardiovascular diseases.4–10 The strict BP control of all these awake BPs would be effective for the reduction of cardiovascular events. However, even after controlling these daytime BPs, there is still a residual risk in the management of hypertension. This is masked uncontrolled nocturnal hypertension. Here, I summarize the clinical implications of the control of night-time BP based on the pathophysiology and recent evidence and present up-to-date information on the research and development of night-time home BP monitoring (HBPM) systems. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). In healthy subjects, night-time BP decreases by 10% to 20% of daytime BP (normal dipper pattern). This circadian rhythm of BP is determined partly by the intrinsic rhythm of central and peripheral clock genes, which regulate the neurohumoral factor and cardiovascular systems, and partly by the sleep–wake behavioral pattern. Hypertensive patients without organ damage also exhibit the dipper pattern; however, those with organ damage tend to exhibit nondipper patterns with diminished night-time BP fall. Night-time BP …

Association of night-time home blood pressure with night-time ambulatory blood pressure and target-organ damage

Night-time ambulatory blood pressure (nABP) is the most important aspect of the blood pressure profile in terms of prognosis. Novel low-cost home monitors allow automated night-time blood pressure monitoring (nHBP). This study reviewed the evidence on the association of nHBP with nABP and preclinical organ damage. Systematic review and meta-analysis. Analysis of six studies (n = 1404) showed pooled difference between nHBP and nABP (SBP/DBP) at 1.4, 95% confidence interval (CI) 0.3, 2.6/-0.2, 95% CI -0.9, 0.6 mmHg, whereas the pooled correlation coefficient between nHBP and nABP (SBP/DBP) was r = 0.70, 95% CI 0.59, 0.81/r = 0.72, 95% CI 0.67, 0.77, respectively. Two studies (n = 212) investigated the agreement between nHBP and nABP in detecting nondippers with weighted agreement 77.3% (pooled kappa 0.27, 95% CI 0.08, 0.45). Three studies (n = 954) reported on the association of left ventricular mass index with systolic nHBP and nABP (pooled correlation coefficient r = 0.36, 95% CI 0.23, 0.50 and r = 0.32, 95% CI 0.10, 0.54, respectively, P = NS for comparison). Two studies (n = 950) reported on the association of urinary albumin excretion with systolic nHBP and nABP (pooled r = 0.39, 95% CI 0.21, 0.58 and r = 0.30, 95% CI 0.06, 0.55, respectively, P < 0.01 for comparison). Two studies (n = 350) reported on the association of common carotid intima-media thickness with systolic nHBP and nABP (pooled r = 0.31, 95% CI 0.16, 0.46 and r = 0.35, 95% CI 0.17, 0.53, respectively, P = NS for comparison). The available evidence suggests that nHBP and nABP present similar values and comparable relationship with target-organ damage. Studies on the prognostic value of nHBP are needed.

Effect of single-pill irbesartan/amlodipine combination-based therapy on clinic and home blood pressure profiles in hypertension with chronic kidney diseases

ABSTRACTWe examined the efficacy of single-pill irbesartan/amlodipine combination-based therapy for 12 weeks in 20 hypertensive chronic kidney disease (CKD) patients, by evaluating self-measured home blood pressure (BP) profile. The single-pill irbesartan/amlodipine combination-based therapy decreased clinic BP and home BP (morning, evening, and nighttime BPs), and improved within-visit clinic BP variability, day-by-day home BP variability (morning and evening), and nighttime home BP variability. Furthermore, the single-pill combination-based therapy reduced albuminuria and exerted improved parameters of vascular function. These results indicate that this single-pill combination-based therapy may exert beneficial effects on clinic and home BP profiles as well as on renal and vascular damages, in hypertension with CKD.

The association between home vs. ambulatory night-time blood pressure and end-organ damage in the general population.

The aim of this study was to test the agreement between night-time home and night-time ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. A population sample of 248 participants underwent measurements for night-time home BP (three measurements on two nights with a timer-equipped home device), night-time ambulatory BP, pulse wave velocity (PWV), carotid intima-media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). No significant or systematic differences were observed between mean night-time ambulatory and home BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, P = 0.16/0.64). All night-time home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (P < 0.01 for all). No significant differences in Pearson's correlations between end-organ damage and night-time home or ambulatory BP were observed (P ≥ 0.11 for all comparisons using Dunn and Clark's Z), except for a slightly stronger correlation between PWV and ambulatory SBP than for home SBP (r = 0.57 vs. 0.50, P = 0.03). The adjusted R of all multivariable-adjusted models for PWV, IMT or LVMI that included night-time home or ambulatory SBP/DBP were within 2/1%. Our study demonstrates that night-time home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring night-time home BP. In the future, night-time home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of night-time BP.

Strategies to handle the challenges of intimacy in night-time home care services

ABSTRACTThe provision of intimate and personal care constitutes a challenge for both careworkers and care recipients and is still a neglected area of research. An observational study of the interaction between the careworkers and care recipients in night-time home care services was conducted in a large municipality in Sweden. The results were analysed in light of previous research and theorising on strategies for handling intimacy in intimate care. The study highlights what appears to be a tension between the ways in which the recipient of care is conceptualised as an active consumer of care in present-day guidelines and the strategies chosen on the part of both caregivers and care recipients, when intimacy and integrity is most at stake, and framed as it is by the care recipients’ situation of dependency and vulnerability. Home care services night-time was shown to be a case that markedly differs from many other settings of intimate care, but in the interactional routines intimate care came forth as a smooth and minimally obtrusive activity. The careworkers and care recipients engaged in strategies such as disattention, eye-discipline, middle-distance orientation, and objectification, thereby serving the purpose of balancing the transgressions of thresholds of intimacy.

Night-time home versus ambulatory blood pressure in determining target organ damage

This study aimed to evaluate the association of night-time blood pressure (BP) assessed by home blood pressure (HBP) or ambulatory blood pressure (ABP) monitoring with preclinical target organ damage in untreated hypertension. Untreated hypertensive study participants were evaluated with ABP monitoring (24-h) and HBP monitoring during daytime (6 days, duplicate morning and evening measurements) and night-time (automated asleep measurements, three nights, 3-hourly measurements/night). Target organ damage was assessed by echocardiographic left ventricular mass index (LVMI), common carotid intima-media thickness (cIMT), urine albumin excretion (UAE), and ankle-brachial index (ABI). A total of 131 study participants were analysed [mean age 52.1 ± 11.9 (SD) years, BMI 29.9 ± 5.3 kg/m2, men 58%, cardiovascular disease history 6.1%]. Daytime and night-time HBP were slightly higher than the respective ABP values (mean difference for systolic daytime/night-time 3.5 ± 10.6/2.6 ± 9.8 mmHg, P < 0.01 for both comparisons and diastolic -0.3 ± 6.8/1.2 ± 6.2 mmHg, P = NS/0.02, respectively). There was a strong correlation between daytime ABP and HBP (r = 0.71/0.72, systolic/diastolic), as well as between the respective night-time values (r = 0.80/0.79; all P < 0.01). Night-time ABP and HBP presented strong and comparable correlations with all the indices of preclinical target organ damage. In multivariate analyses, both LVMI (R2 = 0.26) and cIMT (R2 = 0.25) were determined by night-time systolic HBP, age and male sex; UAE (R2 = 0.28) by night-time systolic HBP and male sex; ABI (R2 = 0.20) by male sex and night-time home pulse pressure. In untreated hypertensives, night-time BP assessed by home monitoring appears to be as good as night-time ambulatory monitoring in determining preclinical target organ damage.

Assessment of the reductions in night-time blood pressure and dipping induced by antihypertensive medication using a home blood pressure monitor

Night-time blood pressure (BP) is strongly associated with hypertensive target organ damage; however, no previous studies have compared home BP monitor measurements of the reduction in night-time BP induced by antihypertensive medications with those obtained with ambulatory BP monitors. As part of the Japan Morning Surge-Target Organ Protection study, in which candesartan (thiazide diuretics were added, if needed) was administered to hypertensive patients in the morning or at bedtime, 50 hypertensive patients had their night-time home and ambulatory BP successfully measured at the baseline and 6 months. In addition, three night-time home BP readings were taken during sleeping hours (at 2, 3, and 4 o'clock) for 6 months. The mean reduction in night-time BP did not differ significantly between home and ambulatory BP monitoring (10.4 ± 17.9/6.0 ± 12.0 vs. 13.3 ± 14.6/7.6 ± 8.9 mmHg, P = 0.219/0.344), but the differences varied among individual patients. The reduction in night-time BP according to home BP monitoring was significantly correlated with the value obtained with ambulatory BP monitoring (r = 0.51/0.38, P < 0.001/=0.006). The reduction in night-time SBP according to home BP monitoring was significantly correlated with the reductions in left ventricular mass index (r = 0.385, P = 0.013, N = 41) and Sokolow-Lyon voltage (r = 0.335, P = 0.035, N = 40). Home BP monitoring produces estimates of mean night-time BP reductions comparable to those from ambulatory monitoring, while the differences varied among individual patients. The reduction in night-time home BP according to home BP monitoring is significantly correlated with the reduction in left ventricular hypertrophy.

Exercise Training in Patients With Chronic Respiratory Failure Due to Kyphoscoliosis: A Randomized Controlled Trial

Research has provided evidence for the safety, feasibility, and efficacy of exercise training in patients with COPD. However, little is known about the impact of exercise training in patients with chronic respiratory failure due to kyphoscoliosis. We evaluated the effect of an exercise training program on exercise capacity, muscle strength, dyspnea, and quality-of-life indices in subjects with chronic respiratory failure due to kyphoscoliosis. The 34 subjects were clinically stable, had been receiving nighttime home mechanical ventilation for ≥ 6 months, and were randomly assigned to the exercise group (n = 17) or the control group (n = 17). The exercise group conducted cycle and strength training on 3 non-consecutive days per week for 12 weeks. We measured pulmonary function, exercise capacity, peripheral muscle strength, dyspnea scores, and quality of life. Statistical analysis was carried out on the data from 16 subjects in the exercise group and in 11 subjects in the control group. Three of the lung-function parameters in the exercise group significantly changed: PaCO2 (P = .04), inspiratory pressure (P = .03), and expiratory pressure (P = .04); and endurance time (P = .002) and shuttle walk distance (P = .001) increased significantly. The exercise group had significantly greater improvements in peripheral muscle strength, dyspnea, and quality of life. In patients with chronic respiratory failure due to kyphoscoliosis, exercise training improved exercise capacity, peripheral muscle strength, dyspnea, and quality of life. (Deutschen Register Klinischer Studien DRKS00000443).

Nighttime Home Blood Pressure and the Risk of Hypertensive Target Organ Damage

In ambulatory blood pressure (BP) monitoring, nighttime BP has a superior ability to predict hypertensive target organ damage than awake BP. We evaluated whether nighttime BP, assessed by a home BP monitor, was associated with hypertensive target organ damage. We measured clinic BP, out-of-clinic BP including nighttime home BP, and the urinary albumin:creatinine ratio (UACR) in 854 patients who had cardiovascular risk factors. Nighttime home BP was measured at 2:00, 3:00, and 4:00 am, in addition to clinic, awake ambulatory, nighttime ambulatory, and awake home BP. Nighttime home systolic BP (SBP) was slightly higher than nighttime ambulatory SBP (difference, 2.6 mm Hg; P<0.001). Clinic (r=0.186), awake ambulatory (r=0.173), nighttime ambulatory (r=0.194), awake home (r=0.298), and nighttime home (r=0.311) SBPs were all associated with log-transformed UACR (all P<0.001). The correlation coefficient for the relationship between nighttime home SBP and log-transformed UACR was significantly greater than that for the relationship between nighttime ambulatory SBP and log-transformed UACR (P<0.001). The goodness of fit of the association between SBP and UACR was improved by adding nighttime home SBP to the other SBPs (P<0.001). Nighttime home diastolic BP also improved the goodness-of-fit of the association between diastolic BP and UACR (P=0.001). Similar findings were observed for the left ventricular mass index in the subgroup (N=594). In conclusion, nighttime home BP is slightly different from (but comparable to) nighttime ambulatory BP. The addition of nighttime home BP to other BP measures improves the association of BP with hypertensive target organ damage.

The Child's Rumbling Slumber

The Child's Rumbling Slumber

Classification Tree Model Identifies Home-based Service Needs of Japanese Long-term Care Insurance Consumers

To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. We used a chi-squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Demographic information, assessments of the statuses and service needs of elders. We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources.

Sleep in Dementia Caregivers and the Effect of a Nighttime Monitoring System

The purpose of this study was to determine if a nighttime home monitoring system, designed to track the movements of a care recipient with dementia, would relieve worry and improve sleep in caregivers of persons with dementia. In this controlled clinical trial, 49 dementia caregivers were followed for up to 1 year. Sleep was measured for 7-day intervals at nine points in time using actigraphy and a sleep diary. Although the experimental caregivers generally reported that the system was "of great help" in relieving worry about nighttime activity, no significant group differences were found using multilevel modeling analyses. With regard to total sleep time, time awake after sleep onset, and sleep quality, multilevel models did not demonstrate any changes in sleep between groups, either averaged over time or for the interaction of group and time. Since previous analysis of our qualitative data suggested improvements in caregiver worry and sleep, problems other than night awakenings may be perpetuating the sleep problem. Future studies should include testing of multimodal sleep interventions. Caregivers have high amounts of unwanted wake time during the night and additional research is needed to identify effective interventions to improve their sleep.