The longitudinal association between the use of antihypertensive drugs and 24-hour sleep in nursing homes. Results from the randomized controlled COSMOS trial

Abstract BackgroundAntihypertensive drug use and sleep problems are highly prevalent in nursing home patients. While it is hypothesized that blood pressure and antihypertensive drug use can affect sleep, this has not been investigated in depth in this population. We aimed to investigate the longitudinal association between antihypertensive drug use, blood pressure and day- and night-time sleep over 4 months.MethodsThis study was based on secondary analyses from the multicomponent randomized controlled COSMOS trial, in which the acronym denotes the intervention: COmmuncation, Systematic pain assessment and treatment, Medication review, Organization of activities and Safety. We included baseline and 4-month follow-up data from a subgroup of nursing home patients who wore actigraphs (n = 107). The subgroup had different levels of blood pressure, from low (< 120) to high (≥ 141). Assessments included blood pressure, antihypertensive drug use, and sleep parameters as assessed by actigraphy.ResultsWe found a significant reduction in total sleep time at month four in the intervention group compared to the control group. When analyzing the control group alone, we found a significant association between antihypertensive use and increased daytime sleep. We also found negative associations between blood pressure, antihypertensive drug use and sleep onset latency in the control group.ConclusionOur results suggest a correlation between excessive daytime sleep and hypertensive drug use. These findings have clinical urgency, as antihypertensive drugs are frequently used in nursing homes, and sleep problems may be especially detrimental for this population.The trial is registered at clinicaltrials.gov (NCT02238652).