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Journal of Clinical Hypertension... Sep 2022Morning hypertension is an important clinical target in the management of hypertension for perfect 24-h blood pressure (BP) control. Morning hypertension is generally...
Morning hypertension is an important clinical target in the management of hypertension for perfect 24-h blood pressure (BP) control. Morning hypertension is generally categorized into two types: "morning surge" type and "sustained nocturnal and morning hypertension" type. The "morning surge" type is characterized by an exaggerated morning blood pressure surge (MBPS), and the "sustained nocturnal and morning hypertension" type with continuous hypertension from nighttime to morning (non-dipper/riser type). They can be detected by home and ambulatory blood pressure measurements (HBPM and ABPM). These two forms of morning hypertension both increase the risk of cardiovascular and renal diseases, but may occur via different pathogenic mechanisms and are associated with different conditions. Morning hypertension should be treated to achieve a morning BP level of < 135/85 mmHg, regardless of the office BP. The second target morning BP levels is < 125/75 mmHg for high-risk patients with morning hypertension and concomitant diseases. Morning hypertension is more frequently found in Asians, than in Westerners. Thus, the management of morning hypertension is especially important in Asia. The detection of morning hypertension and the individual home BP-guided treatment approach targeting morning BP in combination with ABPM, and the optimal treatment of morning hypertension would reduce cardiovascular events in Asia.
Topics: Antihypertensive Agents; Asia; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Circadian Rhythm; Consensus; Humans; Hypertension
PubMed: 36196465
DOI: 10.1111/jch.14555 -
Supportive Care in Cancer : Official... Dec 2022Pain and fatigue are common symptoms in oncology patients. In a sample of oncology outpatients receiving chemotherapy (n = 1342), the study purposes were to identify...
PURPOSE
Pain and fatigue are common symptoms in oncology patients. In a sample of oncology outpatients receiving chemotherapy (n = 1342), the study purposes were to identify subgroups of patients with distinct worst pain and morning fatigue profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as the severity of common symptoms and quality of life (QOL) outcomes.
METHODS
Oncology outpatients receiving chemotherapy (n = 1342) completed self-report questionnaires to assess pain and morning fatigue, a total of six times over two cycles of chemotherapy. Joint latent profile analysis was used to identify subgroups of patients with distinct pain and morning fatigue profiles. Differences among the classes were evaluated using parametric and non-parametric tests.
RESULTS
Five distinct profiles were identified (no pain and low morning fatigue (27.6%), moderate pain and low morning fatigue (28.2%), moderate pain and morning fatigue (28.0%), moderate pain and increasing and decreasing morning fatigue (6.9%), severe pain and very high morning fatigue (9.3%)). Patients with the three worst profiles had clinically meaningful levels of depression and sleep disturbance and decrements in QOL.
CONCLUSIONS
Over 44% of the sample had moderate to high levels of both pain and morning fatigue. Unrelieved pain may contribute to disturbed sleep which results in higher levels of morning fatigue. Clinicians need to assess for pain and fatigue, as well as sleep disturbance during chemotherapy.
Topics: Humans; Quality of Life; Outpatients; Pain Measurement; Fatigue; Neoplasms; Sleep Wake Disorders; Pain; Depression
PubMed: 36355215
DOI: 10.1007/s00520-022-07431-6 -
Journal of Clinical Hypertension... Jun 2022Numerous studies have indicated that there might be great differences among different populations in Europe and Asia in terms of home morning and evening blood pressure... (Meta-Analysis)
Meta-Analysis
Numerous studies have indicated that there might be great differences among different populations in Europe and Asia in terms of home morning and evening blood pressure (BP). Thus, the authors performed a systematic review to determine the quantitative differences of BP measured at clinic versus at home in the morning and in the evening in Europe and Asia. PubMed, Embase, and Scopus databases were searched up to October 2021. Studies that compared clinic BP with home morning and (or) home evening BP in European and Asian populations were included. A random effect model was applied to pool the differences between clinic BP and home morning/evening BP. Thirty-five studies, for a total of 49 432 patients, were included in this meta-analysis. Mean clinic systolic blood pressure (SBP) values were significantly higher than home morning SBP values by 3.79 mmHg (95% CI, 2.77-4.80). The differences were much larger in Europe [(6.53 mmHg (95% CI, 4.10-8.97)] than in Asia [(2.70 mmHg (95% CI, 1.74-3.66)], and the region was a significant predictor for the differences. Mean clinic SBP values were also significantly higher than home evening SBP values by 6.59 mmHg (95% CI, 4.98-8.21). The differences were much smaller in Europe [5.85 mmHg (95% CI, 3.24-8.45)] than in Asia [7.13 mmHg (95% CI, 4.92-9.35)], while age and clinic SBP might contribute to it. Our findings showed that the difference between clinic and home morning SBP was much larger in European than Asian populations, whereas the difference between clinic and home evening SBP was the opposite. The differing characteristics of the region, ethnic, age, and clinic BP might explain the diversities.
Topics: Antihypertensive Agents; Asia; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Circadian Rhythm; Humans; Hypertension
PubMed: 35488438
DOI: 10.1111/jch.14487 -
Scientific Reports Sep 2023The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following...
The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following positive airway pressure therapy. One hundred and sixteen participants were enrolled in this study; all of them received positive airway pressure therapy for at least 3 months. We checked the differences in various sleep apnea-related parameters according to the presence of morning headache and evaluated the improvement of morning headache following positive airway pressure therapy. Among the 116 study participants, 103 were men, with a mean age and body mass index of 50.34 ± 10.23 years and 28.00 ± 4.21 kg/m, respectively. The severity of morning headache was higher in the severe obstructive sleep apnea group than in the mild to moderate group (2.16 ± 1.70 vs. 1.50 ± 1.57, P = 0.027). However, the various polysomnographic parameters did not significantly differ according to the presence of headache. The Epworth sleepiness scale score was significantly higher in the morning headache presence group than in the absence group (10.90 ± 5.45 vs. 8.13 ± 4.27, P = 0.003). Furthermore, a notable correlation was observed between the reduction in daytime sleepiness and the improvement in morning headache following PAP treatment (r = 0.503, P < 0.001). Morning headache significantly improved following positive airway pressure therapy (prevalence: 53.4-16.4%; severity: 1.92 ± 1.67 vs. 0.86 ± 0.80, all P < 0.001), especially in the patients with morning headache before positive airway pressure therapy. Morning headache is significantly associated with daytime sleepiness and positive airway pressure therapy improves morning headache.
Topics: Male; Humans; Adult; Female; Sleep Apnea, Obstructive; Physical Therapy Modalities; Sleep Apnea Syndromes; Body Mass Index; Headache
PubMed: 37669991
DOI: 10.1038/s41598-023-34896-0 -
Developmental Psychobiology Sep 2021The present study examined testosterone (T) and cortisol (Cort) in fathers engaged with caregiving. We collected saliva samples in the mornings and evenings of two...
The present study examined testosterone (T) and cortisol (Cort) in fathers engaged with caregiving. We collected saliva samples in the mornings and evenings of two consecutive days in 150 fathers of 1- to 5-year-old children. Fathers completed questionnaires on socioeconomic status, family structure and life, sleep characteristics and body mass index (BMI), and reported on their engagement in childcare. Fathers used smartphone-based experience sampling throughout 1 week to sample ongoing activities with their children, including times of supervision, joint play, rough-and-tumble play, and cuddling episodes. External observers rated father-child attachment during a home visit. We began by testing for widely characterized covariates of T and excluded seasonal variations and known predictors associated with lowered T, such as older fathers and those with multiple and young children, lower BMI, shorter sleep duration, and sexual activity before sampling. Most interestingly, however, fathers' engagement in childcare and attachment to the child appeared more pronounced the greater the diurnal decline in T. Cuddling predicted a similar negative association, whereas joint play and rough-and-tumble play (RTP) showed enhancing effects on declining T. Interestingly, all fathering behaviors (except RTP) were positively related to lower Cort. In contrast, supervision was ineffective on both Cort and T.
Topics: Child Care; Child, Preschool; Father-Child Relations; Humans; Hydrocortisone; Male; Parenting; Paternal Behavior; Testosterone
PubMed: 34173236
DOI: 10.1002/dev.22149 -
International Journal of Preventive... 2021This study was performed to determine the association of Pre-hypertension/hypertension (pre-HTN/HTN) with leisure-time activities and morning exercise at school in a...
BACKGROUND
This study was performed to determine the association of Pre-hypertension/hypertension (pre-HTN/HTN) with leisure-time activities and morning exercise at school in a sample of Iranian adolescents.
METHODS
This secondary study has done using data of 1992 adolescents participated in of Isfahan Healthy Heart Program. The outcome variable was having/not having pre-hypertension/hypertension (pre-HTN/HTN). The students with Blood pressure (BP) between 90 to 95 percentiles were considered as positive pre-HTN and students with BP >95 percentile were considered as positive HTN. Students with pre-HTN or HTN were considered as positive pre-HTN/HTN. The asked leisure-time activities were categorized in three group including first (ping-pong, basketball, and volleyball), second (football, walking, and bicycling) and sedentary activities (watching TV, studying, and computer gaming), using factor analysis.
RESULTS
The prevalence of pre-HTN and HTN was 16.1% and 6.7%, respectively. Based on multiple logistic regression pre-HTN/HTN was associated just with sedentary activities and morning exercise at school. Odds Ratio (95% confidence interval) for sedentary activities and morning exercise at school was 1.51 (1.13-2.01) and 0.63 (0.44-0.89), respectively.
CONCLUSION
We observed adolescents who engaged in morning exercise at school had lower prevalence of HTN while those who spent more times on sedentary activities were in higher risk for HTN. We suggest to permanent holding of morning exercise and educational programs on healthy lifestyle skills for adolescents by schools.
PubMed: 34912507
DOI: 10.4103/ijpvm.IJPVM_41_19 -
Journal of Sleep Research Apr 2023The relationship between daytime light, especially morning light and sleep, has not been well documented. People who work in an office spend most of their time indoors...
The relationship between daytime light, especially morning light and sleep, has not been well documented. People who work in an office spend most of their time indoors and thus have less access to high-level daylight. The current study employed a field intervention approach to investigate whether exposure to 1.5 h of bright electric light in the early morning for 1 workweek would benefit sleep among students who spent most of their time in an office at the university. Twelve students (24.92 ± 1.78 years) underwent a 2 workday baseline measurement and two inconsecutive 5 workday interventions (with 1 week washout) with morning bright light and regular office light (1000 lx, 6500 K vs. 300 lx, 4000 K, at eye level). The sleep outcomes were recorded with actigraphy and a sleep diary. In addition, self-ratings of daytime sleepiness, mood, mental fatigue, perceived effort, and next morning sleepiness were measured each workday. The results showed that exposure to morning bright light versus regular office light yielded a higher sleep efficiency (83.82% ± 1.60 vs. 80.35% ± 1.57, p = 0.02), a smaller fragmentation index (15.26% ± 1.31 vs. 17.18% ± 1.28, p = 0.05), and a shorter time in bed (7.12 ± 0.13 vs. 7.51 ± 0.12, p = 0.03). Meanwhile, an earlier sleep onset time, shorter sleep latency, and lower morning sleepiness were observed after a 5 workday morning bright light intervention compared with the baseline (ps <0.05), no such benefit was found for self-ratings (ps >0.05). These findings support existing evidence that morning bright light could function as an enhancer of sleep and alertness for office occupants.
Topics: Humans; Sleepiness; Sleep; Cognition; Sleep Disorders, Circadian Rhythm; Students; Circadian Rhythm; Light
PubMed: 36058557
DOI: 10.1111/jsr.13724 -
Journal of Clinical Nursing Jun 2022The present study investigated whether morning or afternoon activity is more effective at increasing the high-frequency (HF) index, a parasympathetic index, in patients... (Observational Study)
Observational Study
AIMS AND OBJECTIVES
The present study investigated whether morning or afternoon activity is more effective at increasing the high-frequency (HF) index, a parasympathetic index, in patients with cardiovascular risk factors.
BACKGROUND
A decreased HF index, a heart rate variability (HRV) parameter, is a well-established marker of poor cardiovascular prognosis. Because blood pressure and sympathetic tone are higher in the morning, physical activity and exercise in the afternoon has been recommended for patients with cardiovascular diseases. However, there have been no reports concerning the superior effects of afternoon exercise on parasympathetic activity and sleep.
DESIGN
This observational study was a post hoc comparison.
METHODS
Patients' physical activity was measured for 1 month to determine their habits. Patients' HF index was measured by 24-h Holter electrocardiography. The study enrolled 56 patients. Each patient's morning step count (before lunch) and afternoon step count (between lunch and dinner) were compared. We adhered to the STROBE guidelines in the present study.
RESULTS
Thirty-one patients took more steps in the morning, and 25 patients took more steps in the afternoon. The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and during sleep than those who took more steps in the morning (p = .003, .047).
CONCLUSIONS
The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and a higher HF index during sleep than those who took more steps in the morning.
RELEVANCE TO CLINICAL PRACTICE
Exercise in the afternoon may improve the prognosis in patients with cardiovascular disease by not only preventing excessive blood pressure, afterload, and sympathetic tone but also positively influencing the parasympathetic system and sleep.
Topics: Cardiovascular Diseases; Heart Disease Risk Factors; Heart Rate; Humans; Risk Factors; Sleep
PubMed: 34459051
DOI: 10.1111/jocn.16018 -
Pain Medicine (Malden, Mass.) Jul 2023Fibromyalgia is characterized by chronic widespread pain, mood, and sleep disturbance. Pharmacological treatments have modest efficacy and are associated with negative... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Fibromyalgia is characterized by chronic widespread pain, mood, and sleep disturbance. Pharmacological treatments have modest efficacy and are associated with negative side effects, and alternative approaches are needed. Morning bright light treatment may assist in the management of fibromyalgia as it can reduce depressive symptoms, improve sleep, and advance circadian timing.
METHODS
Sixty people with fibromyalgia (58 women, mean age 41.8 ± 13.3 years) were enrolled in a study comparing 4 weeks of a 1-hour daily morning bright light treatment (active treatment) to a morning dim light treatment (comparison treatment). Both light treatments included behavioral procedures to stabilize sleep timing. The morning bright light treatment was expected to produce larger improvements in pain and function than the dim light treatment and larger improvements in potential mediators (mood, sleep, and circadian timing).
RESULTS
Both the bright and dim light treatment groups achieved significant but similar levels of improvement in pain intensity, pain interference, physical function, depressive symptoms, and sleep disturbance. Overall, the sample on average displayed a clinically meaningful improvement in the Fibromyalgia Impact Questionnaire-Revised score (mean reduction of 11.2 points), comparable to that reported following physical exercise treatments. Minimal side effects were observed.
CONCLUSIONS
Findings indicate that the effects of a morning bright light treatment did not exceed those of a comparison dim light treatment; yet the changes on average in both conditions revealed clinically meaningful improvements. Future research is warranted to identify what elements of this trial may have contributed to the observed effects.
Topics: Humans; Female; Adult; Middle Aged; Fibromyalgia; Phototherapy; Sleep; Chronic Pain; Surveys and Questionnaires; Circadian Rhythm
PubMed: 36715638
DOI: 10.1093/pm/pnad007 -
Journal of Alzheimer's Disease : JAD 2022High day-to-day blood pressure variability (BPV) has been associated with an increased risk for cognitive decline and mortality in the general population. Whether BPV is...
BACKGROUND
High day-to-day blood pressure variability (BPV) has been associated with an increased risk for cognitive decline and mortality in the general population. Whether BPV is associated with increased all-cause mortality in older people with cognitive impairment is unknown.
OBJECTIVE
To investigate the association between day-to-day home BPV and all-cause mortality in older patients attending a memory clinic.
METHODS
We included 279 patients attending a memory clinic, who measured home blood pressure (BP) for 7 consecutive days in the morning and evening. Within-subject BPV was defined as the variation independent of the mean (VIM). Time-to-death was verified through the Dutch population registry. Cox proportional hazard regression was used. Separate analyses were performed for morning-to-morning and evening-to-evening BPV.
RESULTS
Mean age was 73±9 years, dementia and mild cognitive impairment were diagnosed in 35% and 34% respectively, and mean home BP was 139/79 mmHg. After a mean follow-up of 3.2 years, 52 patients had died. Neither day-to-day systolic nor diastolic VIM were associated with mortality (adjusted hazard ratio [HR] systolic VIM: 0.99, 95% -CI 0.92-1.06, p = 0.770, HR diastolic VIM: 1.04, 95% -CI 0.93-1.17, p = 0.517). When morning and evening measurements were analyzed separately, systolic morning-to-morning VIM was associated with mortality (adjusted HR: 1.09, 95% -CI 1.01-1.18, p = 0.033).
CONCLUSION
In this study, day-to-day BPV was not associated with all-cause mortality in patients attending a memory clinic. However, morning-to-morning BPV was. Due to the short assessment window, there is still a lack of clarity; hence future research is warranted to clarify the role of all BPV components in aging.
Topics: Aged; Aging; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cognitive Dysfunction; Female; Humans; Male; Mortality; Risk Factors
PubMed: 34924378
DOI: 10.3233/JAD-215002