Blood Pressure Cuff Inflation Briefly Increases Adolescent Females’ Restlessness During Sleep on the First but not Second Night of Ambulatory Blood Pressure Monitoring

• Authors: H. Matthew Lehrer, University of Pittsburgh; Gehui Zhang, University of Pittsburgh; Karen A. Matthews, University of Pittsburgh; Robert T. Krafty, Emory University; Marissa A. Evans, University of Pittsburgh; Briana J. Taylor, Maine Medical Center Research Institute; Martica H. Hall, University of Pittsburgh
• Journal Title: Psychosomatic Medicine
• Volume: Volume 84, Number 7
• Publisher: Wolters Kluwer Health Inc. | 2022-06-24, Pages 828-835
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/PSY.0000000000001098
• Subjects: Health Sciences, General
• Keywords: Sleep; ambulatory assessment; actigraphy; blood pressure; adolescence; methods

Abstract

Objective: Ambulatory blood pressure monitoring (ABPM) increases restlessness during adults’ sleep in laboratory settings, but there is little evidence of an association among adolescents or in naturalistic environments. This study examined activity levels before and after BP cuff inflation during sleep to determine whether, and for how long, ABPM increased restlessness during sleep in healthy adolescents. Methods: Two hundred thirty-four healthy adolescents (mean age: 15.72 [1.30] years; 54% females; 57% Black) completed two consecutive nights of hourly ABPM and wrist-worn actigraphy. Activity counts during sleep, averaged across 5-minute bins, were compared in the 20 minutes before and after BP cuff inflation using a four-level mixed model (bins within hours within nights within participants). Interactions of bin with night, sex, and race were examined. Covariates included age, sex, and race. Results: Activity counts in the 5-minute bin immediately following cuff inflation were 10–14% higher than all other bins before (p < .001) and after (p < .001) cuff inflation. This effect differed by night and sex, as activity levels during 5-minutes post-cuff inflation were elevated only on night 1 (ps < .001) and only in females (ps < .001). Effects did not differ by race. Conclusions: Cuff inflation during ABPM briefly increased adolescent females’ restlessness during sleep. Habituation occurred after one night, so two nights of ABPM may minimize impact on sleep. If only one night of ABPM is feasible, excluding five minutes of actigraphy data after each cuff inflation may accommodate the impact of ABPM on restlessness during sleep.