Correlation of Pulse Transit Time, Respiratory Indices, Blood Pressure and Body Mass Index in Normotensive Adults: A Cross-Sectional Study

Main Article Content

Anil Kumar Gangwar
Anita Rawat
Sunita Tiwari
Ajay Verma
Kalpana Singh
Surya Kant

Keywords

Sleep quality, micro-arousals, Pulse transit time, Blood pressure

Abstract

Background: Poor sleep health may be a potential risk factor for cardiovascular diseases, if proper sleep hygiene is not maintained during young adult life-span. Objective was to assess the correlation of frequency of micro-arousals and blood pressure (BP) with body mass index (BMI) among normotensive young adults. Thus, this cross-sectional study examines PTT, respiratory indices, blood pressure, and BMI in normotensive adults to find early physiological indicators of cardiovascular risk.


Methodology: A total number of 80 subjects were enrolled and were divided into two groups according to BMI, after ethical approval (No.: 2651/R.Cell-72) from the institute. BMI and blood pressure were taken. Sleep quality was assessed by Pittsburgh sleep quality index (PSQI). Pulse transit time (PTT) indices and respiratory indices were measured by full night polysomnography.


Results: Subjects with high value of BMI showed poor sleep quality and high value of pulse transit time deceleration index compared to subjects with lower BMI and difference was statistically significant. Subjects with higher BMI had higher value of systolic BP (SBP) and diastolic BP (DBP). SBP and DBP were positively correlated with PTT deceleration index and correlation coefficient was 0.127, 0.634, respectively, and correlation of DBP with PTT deceleration index was statistically significant (p < 0.001), in subjects having higher BMI.


Conclusions: There is higher prevalence of poor sleep quality and higher frequency of micro-arousals in subjects with high BMI. PTT deceleration index is negatively correlated with body mass index and this correlation is statistically significant. BMI shows positive correlation with systemic blood pressure.

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References

1. Global status report on non-communicable diseases Geneva: World Health Organization,2011 [Accessed on December 21,2021]. http://www.who.int/nmph/publications/ncd_reports2010/en
2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-128.
3. Gangwar A, Tiwari S, Rawat A, Verma A, Singh K, Kant S, et al. Circadian Preference, Sleep Quality, and Health impairing Lifestyles Among Undergraduates of Medical University. Cureus 2018;10: e2856.
4. Murray CJL, Vos T, Lozano R, et al. Disability –adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-223.
5. Rawat A, Gangwar AK, Tiwari S, Kant S, Garg RK, Singh PK. Sleep quality and insulin resistance in adolescent subjects with different circadian preference: A cross-sectional study. J Family Med Prim Care 2019;8:2502-5.
6. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67: 968-77.
7. Masuo K, Mikami H, Itoh M, Ogihara T, Tuck ML. Sympathetic activity and body mass index contribute to blood pressure levels. Hypertens Res 2000;23:303–10.
8. Davies RJO, Jenkins NE, Stradlingj R. Effect of measuring ambulatory blood pressure on
9. Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6:199–204.
10. Bogert LW, van Lieshout JJ. Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger. Exp Physiol. 2005;90:437–46.
11. Gesche H, Grosskurth D, Küchler G, Patzak A. Continuous blood pressure measurement by using the pulse transit time: comparison to a cuff-based method. Eur J Appl Physiol. 2012;112:309–15.
12. Bilo G, Zorzi C, Ochoa Munera JE, Torlasco C, Giuli V, Parati G. Validation of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Blood Press Monit. 2015;20:291–4.
13. Kim SH, Song JG, Park JH, Kim JW, Park YS, Hwang GS. Beat-to-beat tracking of systolic blood pressure using noninvasive pulse transit time during anesthesia induction in hypertensive patients. Anesth Analg. 2013;116:94–100.
14. Kario K. Evidence and perspectives on the 24-h management of hypertension: hemodynamic biomarker-initiated ‘anticipation medicine’ for zero cardiovascular event. Prog Cardiovasc Dis. 2016;59:262–81.
15. Kario K, Hettrick DA, Prejbisz A, Januszewicz A. Obstructive sleep apnea-induced neurogenic nocturnal hypertension: a potential role of renal denervation? Hypertension. 2021;77:1047–60.
16. Hu J, Chu GP, Huang FF, Zhou YK, Teng CG, Yang HB, et al. Relation of body mass index (BMI) to the prevalence of hypertension in children: A 3 years' school-based prospective study in Suzhou, China. Int J Cardiol. 2016;222:270–4.
17. Rachmi CN, Agho KE, Li M, Baur LA. Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence? Int J Public Health. 2017;62(1):153–62.
18. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-70.
19. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Res 1989;28:193-213.
20. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-45.
21. Garrison RJ, Kannel WB, Stokes J, Castelli WP. Incidence and precursors of hypertension in young adults: The Framingham Offspring Study. Prev Med 1987;16:234-51.
22. Vanderlei LCM, Pastre CM, Freitas Jr IF, Godoy MF. Analysis of cardiac autonomic modulation in obese and eutrophic children. Clinics (Sao Paulo) 2010;65:789–92.
23. Yadav RL, Yadav PK, Yadav LK, Agrawal K, Sah SK, Islam MD. Association between obesity and heart rate variability indices: an intuition toward cardiac autonomic alteration – a risk of CVD. Diabetes Metab Syndr Obes 2017;10:57–64
24. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829–36.
25. Lee JA, Park HS. Relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents. Nutr Metab Cardiovasc Dis 2014;24:65–71.
26. Kuciene R, Dulskiene V. Associations of short sleep duration with prehypertension and hypertension among Lithuanian children and adolescents: a cross-sectional study. BMC Public Health 2014;14:255.
27. Narang I, Manlhiot C, Davies-Shaw J, Gibson D, Chahal N, Stearne K, et al. Sleep disturbance and cardiovascular risk in adolescents. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2012;184, E913–E920.
28. Chakrabarti B, Emegbo S, Craig S, Duffy N, O'Reilly J. Pulse transit time changes in subjects exhibiting sleep-disordered breathing. Respir Med. 2017;122:18-22.
29. Kalantari E, Kalantari F, Edalatifard M, Rahimi B. Evaluating changes in pulse transit time drop index in patients with obstructive sleep apnea before and during CPAP therapy. Clin Respir J. 2022;16(6):611-617.
30. Finnegan E, Davidson S, Harford M, Jorge J, Watkinson P, Young D, et al. Pulse arrival time as a surrogate of blood pressure. Sci Rep. 2021;11:22767.
31. Mukkamala R, Hahn JO, Inan OT, Mestha LK, Kim CS, Töreyin H, et al. Towards ubiquitous blood pressure monitoring via pulse transit time: Theory and practice. IEEE Trans Biomed Eng. 2015;62(8):1879-1901.
32. Kang MG, Kim KH, Koh JS, Park JR, Hwang SJ, Hwang JY, et al. Association between pulse pressure and body mass index in hypertensive and normotensive populations in the Korea National Health and Nutrition Examination Survey V, 2010–2012. J Clin Hypertens. 2017;19(4):395-401.
33. Pitson DJ, Stradling JR. Autonomic markers of arousal during sleep in patients undergoing investigation for obstructive sleep apnoea, their relationship to EEG arousals, respiratory events and subjective sleepiness. J Sleep Res 1998;7:53-9.