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The definition of daytime and nighttime influences the interpretation of ABPM in children

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Abstract

To test if an arbitrary definition of day and night periods that differs to patient-reported awake and sleep periods leads to inaccuracies in interpretation of ambulatory blood pressure monitoring (ABPM). A single-center, retrospective review was performed comparing three different methods to classify day and night periods following a single 24-h ABPM: method A: Patient's record during monitoring; method B: 7:00 am to 11:00 pm day and 11:00 pm to 7:00 am night; method C: 8:00 am to 8:00 pm day and midnight to 6:00 am night. We included 149 studies in 149 children with a mean ± SD age of 13.0 ± 3.4 years. Reported sleep duration was 9.2 ± 1.3 h. Significant differences resulted between three methods for the means of several ambulatory BP parameters including indexed BP values during day, BP load, and nocturnal dipping status. During monitoring [median (range)], 7.5% (0.0–27.5%) readings were misclassified using method B and 0.0% (0.0–20.0%) using method C (p < 0.0001). This misclassification resulted in change of hypertension status for 11.4% (17/149) patients using method B and 9.4% (14/149) patients using method C (p = 0.70). Misclassification of measurements during ABPM can introduce significant errors in its interpretation. The clinical impact of these findings needs further evaluation in larger prospective studies.

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Acknowledgements

This manuscript was presented in part as an abstract at the Annual Meeting of the European Society of Pediatric Nephrology in 2008 at Lyon, France. MDS acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King’s College Hospital NHS Foundation Trust.

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  1. Department of Paediatric Nephrology, Evelina Children’s Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

    Helen E. Jones & Manish D. Sinha

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  1. Helen E. Jones
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  2. Manish D. Sinha
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Correspondence to Manish D. Sinha.

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Jones, H.E., Sinha, M.D. The definition of daytime and nighttime influences the interpretation of ABPM in children. Pediatr Nephrol 26, 775–781 (2011). https://doi.org/10.1007/s00467-011-1791-3

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  • DOI: https://doi.org/10.1007/s00467-011-1791-3

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