Reverse nocturnal blood pressure dipping in Parkinson's disease is affected by physical activity but not sleep disturbances

Abstract

Background: Individuals with Parkinson's disease (PD) often have reverse nocturnal blood pressure (BP) dipping, which might affect their risks of target organ damage, cardiovascular events, and premature death. The factors that are relevant to reverse BP dipping in PD patients are unknown. Aim: We investigated the relationship between reverse nocturnal BP dipping and daily physical activity and the nocturnal sleep state in PD. Methods: Sixty-seven patients with PD underwent demographic analyses and a postural challenge for detecting orthostatic hypotension, followed by 24-h ambulatory blood pressure monitoring. All patients completed the Parkinson's Disease Questionaire-39 (PDQ-39) concerning their quality of life and the Parkinson's Disease Sleep Scale-2 (PDSS-2) regarding sleep disturbances. Results: Our analysis of the patients' circadian BP rhythms identified dippers (n = 22 patients, 33%), non-dippers (n = 25, 37%), and reverse dippers (n = 20, 30%). The PDQ-39 revealed that the reverse dippers had a significantly higher summary index and higher mobility, emotional well-being, and stigma scores than the non-dippers and dippers, suggesting an association with physical activity. On the PDSS-2, the scores for sleep disturbances, nocturnal motor symptoms, and nocturnal PD symptoms as well as the total score were comparable among the dipper, non-dipper, and reverse dipper groups. Conclusion: The reverse nocturnal BP dipping in PD was suggested to be due in part to decreased physical activity. No association between reverse nocturnal BP reduction and sleep disturbances was demonstrated. Further investigations of reverse nocturnal BP dipping and physical activity might yield new strategies to improve PD patients' life expectancy.