Orthostatic hypotension and subjective sleep quality in older people.

Poor sleep quality and orthostatic hypotension are common complaints in an older population, and both are related to factors such as polypharmacy and depression. However, it is not known whether there is a direct association between the two. Our objective is to investigate a potential association between orthostatic blood pressure response and subjective sleep quality in older people. A within-subjects, cross-sectional design embedded in a larger longitudinal study design. Participants were recruited from the community to visit the TRIL clinic at St James's Hospital, where they underwent a structured medical and psychosocial assessment. A total of 505 community dwelling adults aged 60+ (321 females, mean age 72.44) were participated in this study. Orthostatic blood pressure responses were recorded during an active stand using Finometer equipment, and health-related factors such as pain ratings, co-morbidities, polypharmacy, timed up and go, Mini-Mental State Examination score, body mass index, as well as depression, anxiety, age and gender, were also recorded. Self-reported sleep quality was also assessed using the Pittsburgh Sleep Quality Index. The results showed that timed up and go, polypharmacy, depression, anxiety, gender and delayed recovery of blood pressure at orthostasis were associated with subjective poor sleep quality. There is an association between subjective sleep quality and delayed recovery of blood pressure at orthostasis, independent of mental health or polypharmacy effects, in older adults. This link may have implications for the management of sleep disorders in older people.

Factors affecting continuous beat-to-beat orthostatic blood pressure response in community-dwelling older adults.

OBJECTIVE: To examine the effect of age, time of day, the timing of medication and food ingestion on orthostatic blood pressure response (OBP) in community-dwelling adults. METHODS: A nationally representative sample of 109 community-dwelling adults aged at least 50 years attended for health assessment in a pilot study of The Irish Longitudinal Study on Ageing. OBP was measured using continuous beat-to-beat plethysmography (Finometer) during active stand, and OBP with excessive artefacts were excluded. Nine outcome variables were supine systolic blood pressure (SBP), lowest standing SBP (nadir), standing SBP at 40, 60 and 120 s and the difference in supine SBP and nadir (delta SBP) and delta at 40, 60 and 120 s. Factors included for multiple linear regression analysis were age, time of assessment, interval from the last meal and whether regular medications were taken on the day. Subgroup analysis was performed on 103 respondents who were not on ß-blocker, fludrocortisone and Parkinson medications. RESULTS: There were 53 men, mean age 62.1 (SD=9.4) years. Older respondents (≥60 years) showed greater delta at 40 s by up to 12.9 mmHg. Delta SBP and delta 40, 60 and 120 were not significantly affected by the time of day or food ingestion. The effect of medications on delta 40 was no longer present in subgroup analysis. CONCLUSION: Age was the most significant determinant of OBP and was most strongly associated with greater delta at 40 s. This was independent of the time of day, food and medication ingestion. Continuous beat-to-beat plethysmography provides for a window into the pattern of OBP in community-dwelling adults aged 50 years and older.