背景:睡眠改变对妊娠期焦虑和血压升高(BP)之间关系的潜在影响尚未得到充分研究。我们评估了焦虑之间的关系,失眠,睡眠时间短,以及这些变量之间的任何相互作用影响,怀孕期间的血压。
方法:这是一个在2021年至2022年期间在单一机构妊娠23至36周的孕妇的前瞻性试点队列。使用标准化问卷测量临床失眠和焦虑。使用腕部佩戴的活动描记器测量客观的睡眠持续时间。主要结果是收缩压(SBP),舒张压(DBP),和平均(MAP)非侵入性BP测量。使用与广义估计方程(GEE)拟合的单独的序贯多变量线性回归模型来分别评估焦虑(自变量)和每个BP参数(因变量)之间的关联。在调整潜在的混杂因素后(模型1)。进行了其他分析,将失眠以及焦虑和失眠之间的相互作用作为独立变量(模型2),并将短睡眠时间以及焦虑和短睡眠时间之间的相互作用作为自变量(模型3),评估对BP参数的任何调节作用。
结果:在完成研究的60名参与者中,15(25%)筛查焦虑呈阳性,11人(18%)有主观性失眠,和34(59%)有客观的短睡眠时间。在模型1中,焦虑的增加与任何BP参数的增加无关。当模型2包括主观失眠时,DBP和MAP升高与焦虑显着相关(DBP:β6.1,p=0.01,MAP:β6.2p<0.01)。当模型3包括短睡眠时,所有BP参数均与焦虑显着相关(SBP:β9.6,p=0.01,DBP:β8.1,p<0.001,MAP:β8.8,p<0.001)。在失眠和焦虑之间(p相互作用:SBP0.80,DBP0.60,MAP0.32)或短睡眠时间和焦虑之间(p相互作用:SBP0.12,DBP0.24,MAP0.13)对BP没有调节作用。
结论:当包括主观性失眠或客观短睡眠时,焦虑的孕妇SBP高5.1-9.6mmHg,DBP提高6.1-8.1mmHg,MAP比没有焦虑的人高6.2-8.8mmHg。
BACKGROUND: The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.
METHODS: This was a prospective pilot cohort of pregnant people between 23 to 36 weeks\' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.
RESULTS: Among the 60 participants who completed the
study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.
CONCLUSIONS: When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.