Blood Pressure Variability Indices and Self-Reported Quality of Sleep Among Adolescents Living with HIV

Abstract

Background: Children and adolescents living with HIV (ALHIV) are highly prone to develop cardiovascular diseases (CVDs) in the future. Blood pressure is a predictor for future development of cardiovascular diseases. Ambulatory Blood pressure indices predicts changes in blood pressure better than Office blood pressure. However, most healthcare facilities in Ghana use Office BP and Ambulatory blood pressure has not been used a lot. Most research evaluating the relation between HIV and blood pressure (BP) measurements have mainly focused on the conventional sphygmomanometric method, which carries a significant risk of human error and inaccuracy and does not accurately reflect the blood pressure characteristics of HIV positive patients BP variability Ambulatory blood pressure monitoring (ABPM), is a key instrument for evaluating blood pressure variability (BPV) which is a predictor of hypertensive end-organ damage. This study is a novel study and there is scanty literature on evaluating Blood pressure variability among ALHIV. This study may provide data and literature on blood pressure variability indices and self-reported sleep to help in the management of cardiovascular risk among ALHIV. Cardiovascular disorders among children and adolescents may also be contributed by poor sleep quality. Blood pressure changes over a 24-hour period might occur in HIV positive patients who have sleep disturbances. Lack of sleep may cause sympathetic activity to rise, which could raise blood pressure. General aim of study: The study aims to investigate the relationship between 24-hour ambulatory blood pressure variability indices and self-reported sleep quality among adolescents living with HIV. Methods: A cross-sectional study design was employed for this study. A cluster-randomized sampling technique was used to recruit health facilities and 122 adolescents living with HIV (ALHIV). A 24-hour ABPM was performed using a validated portable ABPM 50 device with the BP readings set at 15 minutes intervals, from 7 am to 10 pm for daytime, and 20 minutes intervals during the night, from 10 pm to 6 am. The Pittsburg Sleep Quality Index (PSQI) Questionnaire was used to assess the quality of sleep. Anthropometric measurement of participants was also conducted. Body weight (in kilograms) and height (in meters) were taken for the calculation of Body mass index (BMI). Variables such as Self-reported sleep quality, BMI, and ART regimen was held as independent variables while Beat-to-beat BPV variables and circadian variability variables were held as dependent variables Results: Ages of participants were from 6 years to 19 years; with a mean age of 13.6 ± 3.2 years. The males were (N=56(45.9%)) and the females were (N=66 (54.1%)). Most of the females (N=32(48.5%)) were aged 14 years and above. Females (N=21(31.8%)) had a healthier BMI compared to males (N=18(32.1%)). There was no significant relationship between gender and BMI of participants, p value= 0.25. Relationship between gender and antiretroviral therapy (ART) regimen was not significant, p-value=0.304. For sleep quality comparison among genders, most females reported poor sleep quality, (N=18(27.3%)). Most females had good sleep quality (N=48(72.7%)). Hypertension was reported among (N=13 (10.6)) of which (N=2 (1.64%) reported Hypertension stage 1 (>=pct90 and <pct95 mmHg), Hypertension stage II was (N=1 (0.82%)), Isolated Diastolic Hypertension (IDH) was (N=6 (4.82)), Isolated Systolic Hypertension (ISH) (>(pct99+5 mmHg/<pct90mmHg) was (N=3 (2.5%). The outcome showed no significant association between sleep quality and SD blood pressure Variability since all recorded p-values > 0.05. The p-value for the association between self-reported sleep and circadian variability (Nocturnal dip, p value=0.984, BP surge, p-value = 0.695). Findings from this study showed a significant association between cardiovascular outcomes and blood pressure variability. Cardiovascular outcomes of ALHIV was determined by ambulatory systolic blood pressure and office systolic blood pressure levels. For Ambulatory BP levels, study showed Blood pressure variability; Awake SD BPV increases with increasing ambulatory and office blood pressure, at an R-Squared value = 0.038 and p-value =0.03. Conclusion: Blood pressure variability may have a relationship with cardiovascular outcomes among ALHIV. Findings from this study shows that, as blood pressure variability increases, there is a tendency for blood pressure to also rise. Self-reported sleep quality did not have any significant association with short term blood pressure variability and circadian variability. ART and BMI showed some association with blood pressure variability. The study showed that most ALHIV have elevated blood pressure.