收缩压变异性和睡眠模式对脑卒中的联合预测作用

王雪瑞; 潘玮; 陈明红; 陈隽雨; 彭群勇; 谢伟

doi:10.11817/j.issn.1672-7347.2026.250295

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收缩压变异性和睡眠模式对脑卒中的联合预测作用
Joint predictive effect of systolic blood pressure variability and sleep patterns on stroke
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：287-298
作者机构：

1.中南大学湘雅医院心血管内科，长沙 410008
2.中南大学湘雅医院老年医学科，长沙 410008
作者简介：

王雪瑞，Email: 1520503390@qq.com, ORCID: 0009-0001-3755-0634
谢伟，副主任医师，Email: XIEWEI5874@outlook.com, ORCID: 0009-0002-7306-9407
基金信息：

湖南省自然科学基金(2025JJ50581;09JJ5028┫。This work was supported by the Natural Science Foundation of Hunan Province;China ┣2025JJ50581;09JJ5028)
DOI：10.11817/j.issn.1672-7347.2026.250295
中图分类号：
CSTR：
收稿：2025-06-03，

纸质出版：2026-02-28
稿件说明：

王雪瑞, 潘玮, 陈明红, 陈隽雨, 彭群勇, 谢伟. 收缩压变异性和睡眠模式对脑卒中的联合预测作用[J]. 中南大学学报(医学版), 2026, 51(2): 287-298.

WANG Xuerui, PAN Wei, CHEN Minghong, CHEN Junyu, PENG Qunyong, XIE Wei. Joint predictive effect of systolic blood pressure variability and sleep patterns on stroke[J]. Journal of Central South University. Medical Science, 2026, 51(2): 287-298.
王雪瑞, 潘玮, 陈明红, 陈隽雨, 彭群勇, 谢伟. 收缩压变异性和睡眠模式对脑卒中的联合预测作用[J]. 中南大学学报(医学版), 2026, 51(2): 287-298. DOI：10.11817/j.issn.1672-7347.2026.250295.

WANG Xuerui, PAN Wei, CHEN Minghong, CHEN Junyu, PENG Qunyong, XIE Wei. Joint predictive effect of systolic blood pressure variability and sleep patterns on stroke[J]. Journal of Central South University. Medical Science, 2026, 51(2): 287-298. DOI：10.11817/j.issn.1672-7347.2026.250295.

摘要

目的

收缩压变异性(systolic blood pressure variability，SBPV)和不良睡眠模式已被确定为脑卒中的危险因素，但二者同时存在是否会加重脑卒中风险目前尚不清楚。本研究旨在探讨这2种因素对脑卒中的联合预测作用。

方法

本研究纳入英国生物样本数据库中的219 376名参与者。SBPV为研究前5年内收缩压测量≥3次、范围在60~300 mmHg(1 mmHg=0.133 kPa)的所有记录的标准差。根据SBPV的四分位数将参与者分为4个四分位组(第1、2、3、4四分位组)。基线时采用问卷调查收集睡眠类型、睡眠时长、失眠、打鼾和日间嗜睡5个睡眠特征。参与者每遇到1个健康睡眠特征就得1分，最高累积得分为5，然后将其分为3组：健康睡眠模式组(4~5分)、中等睡眠模式组(2~3分)和不良睡眠模式组(0~1分)。采用Cox比例风险模型评估SBPV和睡眠模式对脑卒中的联合预测作用。

结果

在完全调整协变量后，与健康睡眠模式且SBPV位于第1四分位组的参与者相比，中等睡眠模式且SBPV处于第2、3和4四分位组的参与者脑卒中发病风险分别增加22%(95%

1.05~1.41)、27%(95%

1.10~1.47)和38%(95%

1.20~1.60)；不良睡眠模式且SBPV处于第3、4四分位组的参与者脑卒中风险增加47%(95%

1.17~1.84)、80%(95%

1.47~2.21)。SBPV与睡眠模式存在显著的相乘交互作用(

0.05)。

结论

SBPV和不良睡眠模式对脑卒中存在相乘交互预测作用，提示同时改善SBPV和睡眠模式的重要性。

Abstract

Objective

Systolic blood pressure variability (SBPV) and unhealthy sleep patterns have been identified as risk factors for stroke. However

whether the coexistence of these two factors further increases the risk of stroke remains unclear. This study aims to investigate the joint predictive effect of these two factors on stroke.

Methods

A total of 219 376 participants from the UK Biobank were included in this study. SBPV was defined as the standard deviation of all systolic blood pressure measurements recorded within the previous 5 years

with at least three measurements ranging from 60 to 300 mmHg (1 mmHg=0.133 kPa). Participants were categorized into 4 quartile groups (

) according to the quartiles of SBPV. At baseline

5 sleep characteristics were collected through questionnaires: chronotype

sleep duration

insomnia

snoring

and daytime sleepiness. Participants received 1 point for each healthy sleep characteristic

with a maximum cumulative score of 5. Based on the total score

participants were classified into 3 groups: healthy sleep pattern group (4 to 5 points)

intermediate sleep pattern group (2 to 3 points)

and poor sleep pattern group (0 to 1 point). Cox proportional hazards models were used to evaluate the joint predictive effect of SBPV and sleep patterns on the risk of stroke.

Results

After full adjustment for covariates

compared with participants with a healthy sleep pattern and SBPV in the first quartile (

)

those with an intermediate sleep pattern and SBPV in the second

third

and fourth quartiles had a 22% (95%

1.05 to 1.41)

27% (95%

1.10 to 1.47)

and 38% (95%

1.20 to 1.60) increased risk of stroke

respectively. Participants with a poor sleep pattern and SBPV in the third and fourth quartiles had a 47% (95%

1.17 to 1.84) and 80% (95%

1.47 to 2.21) higher risk of stroke

respectively. A multiplicative interaction between SBPV and sleep patterns was observed (

0.05).

Conclusion

SBPV and poor sleep patterns have a multiplicative interactive predictive effect on stroke risk

highlighting the importance of simultaneously improving SBPV and sleep patterns.

关键词

Keywords

references

Barthels D , Das H . Current advances in ischemic stroke research and therapies [J ] . Biochim Biophys Acta Mol Basis Dis , 2020 , 1866 ( 4 ): 165260 . https://doi.org/10.1016/j.bbadis. 2018.09.012 https://doi.org/10.1016/j.bbadis.2018.09.012 .

Tsao CW , Aday AW , Almarzooq ZI , et al . Heart disease and stroke statistics-2022 update: a report from the American heart association [J/OL ] . Circulation , 2022 , 145 ( 8 ): e153 - e639 [ 2025-04-02 ] . https://doi.org/10.1161/CIR.0000000000001052 https://doi.org/10.1161/CIR.0000000000001052 .

Parati G , Stergiou GS , Dolan E , et al . Blood pressure variability: clinical relevance and application [J ] . J Clin Hypertens , 2018 , 20 ( 7 ): 1133 - 1137 . https://doi.org/10.1111/jch. 13304 https://doi.org/10.1111/jch.13304 .

Stevens SL , Wood S , Koshiaris C , et al . Blood pressure variability and cardiovascular disease: systematic review and meta-analysis [J ] . BMJ , 2016 , 354 : i4098 . https://doi.org/10. 1136/bmj.i4098 https://doi.org/10.1136/bmj.i4098 .

Mena LJ , Felix VG , Melgarejo JD , et al . 24-hour blood pressure variability assessed by average real variability: a systematic review and meta-analysis [J/OL ] . J Am Heart Assoc , 2017 , 6 ( 10 ): e 006895 [ 2025-03-28 ] . https://doi.org/10.1161/JAHA. 117.006895 https://doi.org/10.1161/JAHA.117.006895 .

Palatini P , Reboldi G , Beilin LJ , et al . Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: the Ambulatory Blood Pressure-International Study [J ] . Hypertension , 2014 , 64 ( 3 ): 487 - 493 . https://doi.org/10.1161/HYPERTENSIONAHA.114.03694 https://doi.org/10.1161/HYPERTENSIONAHA.114.03694 .

万政伟 , 孙兆辰 , 瞿晗 . 基于体检随访人群探索收缩压平均真实变异性与心血管疾病的发病风险 [J ] . 中国医药科学 , 2025 , 15 ( 22 ): 109 - 113 . https://doi.org/10.20116/j.issn2095-0616.2025. 22.21 https://doi.org/10.20116/j.issn2095-0616.2025.22.21 .

WAN Zhengwei , SUN Zhaochen , QU Han . Association between long-term systolic blood pressure average real variability and cardiovascular disease based on routine physical examination [J ] . China Medicine and Pharmacy , 2025 , 15 ( 22 ): 109 - 113 . https://doi.org/10.20116/j.issn2095-0616.2025.22.21 https://doi.org/10.20116/j.issn2095-0616.2025.22.21 .

GBD 2016 Neurology Collaborators . Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 [J ] . Lancet Neurol , 2019 , 18 ( 5 ): 459 - 480 . https://doi.org/10.1016/S1474-4422(18)30499-X https://doi.org/10.1016/S1474-4422(18)30499-X .

Tao F , Cao Z , Jiang Y , et al . Associations of sleep duration and quality with incident cardiovascular disease, cancer, and mortality: a prospective cohort study of 407, 500 UK biobank participants [J ] . Sleep Med , 2021 , 81 : 401 - 409 . https://doi.org/10. 1016/j.sleep.2021.03.015 https://doi.org/10.1016/j.sleep.2021.03.015 .

Johnson KA , Gordon CJ , Chapman JL , et al . The association of insomnia disorder characterised by objective short sleep duration with hypertension, diabetes and body mass index: a systematic review and meta-analysis [J ] . Sleep Med Rev , 2021 , 59 : 101456 . https://doi.org/10.1016/j.smrv.2021.101456 https://doi.org/10.1016/j.smrv.2021.101456 .

Li X , Sotres-Alvarez D , Gallo LC , et al . Associations of sleep-disordered breathing and insomnia with incident hypertension and diabetes. the hispanic community health study/study of latinos [J ] . Am J Respir Crit Care Med , 2021 , 203 ( 3 ): 356 - 365 . https://doi.org/10.1164/rccm.201912-2330OC https://doi.org/10.1164/rccm.201912-2330OC .

Wei Y , Lv J , Guo Y , et al . Age-specific associations between habitual snoring and cardiovascular diseases in China: a 10-year cohort study [J ] . Chest , 2021 , 160 ( 3 ): 1053 - 1063 . https://doi. org/10.1016/j.chest.2021.04.070 https://doi.org/10.1016/j.chest.2021.04.070 .

Li D , Liu D , Wang X , et al . Self-reported habitual snoring and risk of cardiovascular disease and all-cause mortality [J ] . Atherosclerosis , 2014 , 235 ( 1 ): 189 - 195 . https://doi.org/10.1016/j. atherosclerosis.2014.04.031 https://doi.org/10.1016/j.atherosclerosis.2014.04.031 .

Wang L , Liu Q , Heizhati M , et al . Association between excessive daytime sleepiness and risk of cardiovascular disease and all-cause mortality: a systematic review and meta-analysis of longitudinal cohort studies [J ] . J Am Med Dir Assoc , 2020 , 21 ( 12 ): 1979 - 1985 . https://doi.org/10.1016/j.jamda.2020.05.023 https://doi.org/10.1016/j.jamda.2020.05.023 .

Šiarnik P , Klobučníková K , Šurda P , et al . Excessive daytime sleepiness in acute ischemic stroke: association with restless legs syndrome, diabetes mellitus, obesity, and sleep-disordered breathing [J ] . J Clin Sleep Med , 2018 , 14 ( 1 ): 95 - 100 . https://doi.org/10.5664/jcsm.6890 https://doi.org/10.5664/jcsm.6890 .

Seo JA , Lee DY , Yu JH , et al . Habitual late sleep initiation is associated with increased incidence of type 2 diabetes mellitus in Korean adults: the Korean Genome and Epidemiology Study [J ] . Sleep , 2019 , 42 ( 7 ): zsz090 . https://doi.org/10.1093/sleep/zsz090 https://doi.org/10.1093/sleep/zsz090 .

He L , Ma T , Wang X , et al . Association between longitudinal change of sleep patterns and the risk of cardiovascular diseases [J ] . Sleep , 2024 , 47 ( 7 ): zsae084 . https://doi.org/10.1093/sleep/zsae084 https://doi.org/10.1093/sleep/zsae084 .

He LF , Ma TQ , Cheng XJ , et al . The association between sleep characteristics and the risk of all-cause mortality among individuals with cardiometabolic multimorbidity: a prospective study of UK Biobank [J ] . J Clin Sleep Med , 2023 , 19 ( 4 ): 651 - 658 . https://doi.org/10.5664/jcsm.10404 https://doi.org/10.5664/jcsm.10404 .

He LF , Ma TQ , Li JC , et al . Adherence to a healthy sleep pattern and incidence of cardiometabolic multimorbidity among hypertensive patients: a prospective study of UK Biobank [J ] . Sleep , 2022 , 45 ( 10 ): zsac141 . https://doi.org/10. 1093/sleep/zsac141 https://doi.org/10.1093/sleep/zsac141 .

Ahn S , Howie-Esquivel J , Davis EM , et al . Association of disrupted sleep with 24-hour blood pressure variability in caregivers [J ] . Heart Lung , 2023 , 60 : 45 - 51 . https://doi.org/10. 1016/j.hrtlng.2023.02.024 https://doi.org/10.1016/j.hrtlng.2023.02.024 .

Zhao QQ , He MM , Zhang M , et al . Non-linear relationship between sleep duration and blood pressure in children with short stature [J ] . Front Pediatr , 2023 , 11 : 1302750 . https://doi.org/10.3389/fped.2023.1302750 https://doi.org/10.3389/fped.2023.1302750 .

Culver MN , McMillan NK , Cross BL , et al . Sleep duration irregularity is associated with elevated blood pressure in young adults [J ] . Chronobiol Int , 2022 , 39 ( 10 ): 1320 - 1328 . https://doi.org/10.1080/07420528.2022.2101373 https://doi.org/10.1080/07420528.2022.2101373 .

Toba A , Ishikawa J , Harada K . Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients [J ] . Blood Press , 2022 , 31 ( 1 ): 40 - 46 . https://doi.org/10.1080/08037051. 2022.2055531 https://doi.org/10.1080/08037051.2022.2055531 .

Kario K . Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure [J ] . Hypertens Res , 2009 , 32 ( 6 ): 428 - 432 . https://doi.org/10.1038/hr.2009.56 https://doi.org/10.1038/hr.2009.56 .

Wali MA , Raparelli V , Pilote L , et al . Blood pressure variability in normotensive perimenopausal women: non-dipping status, maximum blood pressure and arterial stiffness [J ] . Int J Cardiol , 2021 , 325 : 149 - 154 . https://doi.org/10.1016/j.ijcard.2020.10.027 https://doi.org/10.1016/j.ijcard.2020.10.027 .

Kumagai H , Sawatari H , Hoshino T , et al . Nocturnal blood pressure fluctuations in patients with rapid eye movement-related obstructive sleep apnea [J ] . J Clin Med , 2021 , 10 ( 21 ): 5023 . https://doi.org/10.3390/jcm10215023 https://doi.org/10.3390/jcm10215023 .

Nagai M , Hoshide S , Nishikawa M , et al . Sleep duration and insomnia in the elderly: associations with blood pressure variability and carotid artery remodeling [J ] . Am J Hypertens , 2013 , 26 ( 8 ): 981 - 989 . https://doi.org/10.1093/ajh/hpt070 https://doi.org/10.1093/ajh/hpt070 .

Johansson JK , Kronholm E , Jula AM . Variability in home-measured blood pressure and heart rate: associations with self-reported insomnia and sleep duration [J ] . J Hypertens , 2011 , 29 ( 10 ): 1897 - 1905 . https://doi.org/10.1097/HJH.0b013e32834abccd https://doi.org/10.1097/HJH.0b013e32834abccd .

Miller HE , Simpson SL , Hurtado J , et al . Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study [J ] . BMC Pregnancy Childbirth , 2024 , 24 ( 1 ): 366 . https://doi.org/10.1186/s12884-024-06540-w https://doi.org/10.1186/s12884-024-06540-w .

Makarem N , Zuraikat FM , Aggarwal B , et al . Variability in sleep patterns: an emerging risk factor for hypertension [J ] . Curr Hypertens Rep , 2020 , 22 ( 2 ): 19 . https://doi.org/10.1007/s11906-020-1025-9 https://doi.org/10.1007/s11906-020-1025-9 .

Noda A , Okada T , Hayashi H , et al . 24-hour ambulatory blood pressure variability in obstructive sleep apnea syndrome [J ] . Chest , 1993 , 103 ( 5 ): 1343 - 1347 . https://doi.org/10.1378/chest. 103.5.1343 https://doi.org/10.1378/chest.103.5.1343 .

Zbrozyna AW , Westwood DM . Cardiovascular instability during sleep and calm waking state in normal man [J ] . Clin Auton Res , 1992 , 2 ( 2 ): 125 - 132 . https://doi.org/10.1007/BF01819668 https://doi.org/10.1007/BF01819668 .

Schillaci G , Bilo G , Pucci G , et al . Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases [J ] . Hypertension , 2012 , 60 ( 2 ): 369 - 377 . https://doi.org/10.1161/HYPERTENSIONAHA. 112.197491 https://doi.org/10.1161/HYPERTENSIONAHA.112.197491 .

Angeli F , Reboldi G , Verdecchia P . Blood pressure variability and risk of stroke in chronic kidney disease [J ] . J Hypertens , 2020 , 38 ( 4 ): 599 - 602 . https://doi.org/10.1097/HJH. 0000000000002339 https://doi.org/10.1097/HJH.0000000000002339 .

Nagai M , Kario K . Visit-to-visit blood pressure variability, silent cerebral injury, and risk of stroke [J ] . Am J Hypertens , 2013 , 26 ( 12 ): 1369 - 1376 . https://doi.org/10.1093/ajh/hpt167 https://doi.org/10.1093/ajh/hpt167 .

Xiong B , Chen S , Chen W , et al . Advances in renal denervation in the treatment of hypertension [J ] . Cardiovasc Innov Appl , 2023 , 7 ( 1 ): 1 - 15 . https://doi.org/10.15212/cvia.2023.0014 https://doi.org/10.15212/cvia.2023.0014 .

Wang J , Shi X , Ma C , et al . Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease: a systematic review and meta-analysis [J ] . J Hypertens , 2017 , 35 ( 1 ): 10 - 17 . https://doi.org/10.1097/HJH. 0000000000001159 https://doi.org/10.1097/HJH.0000000000001159 .

Rothwell PM , Howard SC , Dolan E , et al . Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension [J ] . Lancet , 2010 , 375 ( 9718 ): 895 - 905 . https://doi.org/10.1016/S0140-6736(10)60308-X https://doi.org/10.1016/S0140-6736(10)60308-X .

Pringle E , Phillips C , Thijs L , et al . Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population [J ] . J Hypertens , 2003 , 21 ( 12 ): 2251 - 2257 . https://doi.org/10.1097/00004872-200312000-00012 https://doi.org/10.1097/00004872-200312000-00012 .

Hata Y , Kimura Y , Muratani H , et al . Office blood pressure variability as a predictor of brain infarction in elderly hypertensive patients [J ] . Hypertens Res , 2000 , 23 ( 6 ): 553 - 560 . https://doi.org/10.1291/hypres.23.553 https://doi.org/10.1291/hypres.23.553 .

Shimbo D , Newman JD , Aragaki AK , et al . Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative [J ] . Hypertension , 2012 , 60 ( 3 ): 625 - 630 . https://doi.org/10.1161/HYPERTENSIONAHA.112.193094 https://doi.org/10.1161/HYPERTENSIONAHA.112.193094 .

Li J , Yin J , Luo Y , et al . Association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes: a prospective cohort study [J ] . Diabetes Res Clin Pract , 2022 , 186 : 109822 . https://doi.org/10. 1016/j.diabres.2022.109822 https://doi.org/10.1016/j.diabres.2022.109822 .

Sudlow C , Gallacher J , Allen N , et al . UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age [J/OL ] . PLoS Med , 2015 , 12 ( 3 ): e 1001779 [ 2025-04-11 ] . https://doi.org/10.1371/journal. pmed.1001779 https://doi.org/10.1371/journal.pmed.1001779 .

Hippisley-Cox J , Coupland C , Brindle P . Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study [J ] . BMJ , 2017 , 357 : j2099 . https://doi.org/10.1136/bmj.j2099 https://doi.org/10.1136/bmj.j2099 .

Fan MY , Sun D , Zhou T , et al . Sleep patterns, genetic susceptibility, and incident cardiovascular disease: a prospective study of 385 292 UK biobank participants [J ] . Eur Heart J , 2020 , 41 ( 11 ): 1182 - 1189 . https://doi.org/10.1093/eurheartj/ehz849 https://doi.org/10.1093/eurheartj/ehz849 .

Ebrahim IO , Shapiro CM , Williams AJ , et al . Alcohol and sleep I: effects on normal sleep [J ] . Alcohol Clin Exp Res , 2013 , 37 ( 4 ): 539 - 549 . https://doi.org/10.1111/acer.12006 https://doi.org/10.1111/acer.12006 .

Kollias A , Kyriakoulis KG , Stergiou GS . Evidence on the clinical relevance of short-term blood pressure variability? Untying the Gordian knot [J ] . Eur J Prev Cardiol , 2022 , 29 ( 10 ): 1375 - 1376 . https://doi.org/10.1093/eurjpc/zwac037 https://doi.org/10.1093/eurjpc/zwac037 .

Gangwisch JE . Epidemiological evidence for the links between sleep, circadian rhythms and metabolism [J ] . Obes Rev , 2009 , 10 Suppl 2 ( 0 2 ): 37 - 45 . https://doi.org/10.1111/j.1467-789X. 2009.00663.x https://doi.org/10.1111/j.1467-789X.2009.00663.x .

van Leeuwen WMA , Sallinen M , Virkkala J , et al . Physiological and autonomic stress responses after prolonged sleep restriction and subsequent recovery sleep in healthy young men [J ] . Sleep Biol Rhythms , 2018 , 16 ( 1 ): 45 - 54 . https://doi. org/10.1007/s41105-017-0122-x https://doi.org/10.1007/s41105-017-0122-x .

Hirshkowitz M , Whiton K , Albert SM , et al . National Sleep Foundation’s sleep time duration recommendations: methodology and results summary [J ] . Sleep Health , 2015 , 1 ( 1 ): 40 - 43 . https://doi.org/10.1016/j.sleh.2014.12.010 https://doi.org/10.1016/j.sleh.2014.12.010 .

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