Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosing nocturnal hypertension, providing continuous 24-hour blood pressure assessment at preset intervals. However, its repeated cuff inflations during sleep represent a significant yet underexplored source of sleep disturbance. Prior surveys have reported that over 50% of ABPM users experience sleep disruption. Critically, sleep arousal is itself a known trigger of nocturnal blood pressure surges via sympathetic activation; therefore, cuff-induced arousals may paradoxically elevate the blood pressure measurements the device aims to capture, potentially compromising diagnostic accuracy. Despite this concern, the precise effect on sleep arousal has not been rigorously quantified in a large-scale PSG cohort, leaving a critical gap in both clinical interpretation and device evaluation.
This study analyzed PSG data from 91 subjects who underwent two nights of recording — one with ABPM and one without. A cuff-effect window was defined as two epochs before and after each ABPM event, with a one-epoch pre-cuff window used to exclude events preceded by wake, REM sleep, or prior arousal. Sleep arousal was detected using an EEG-based algorithm grounded in AASM criteria, identifying frequency shifts toward alpha or beta components with alpha/beta power ≥ 2× baseline and delta power ≤ 0.5× baseline, sustained for at least 3 seconds. Responses were categorized as stable sleep, arousal, or wake.
Paired t-tests revealed that arousal probability was significantly higher following cuff inflation (p < .001), whereas wake proportion showed no significant difference. These findings confirm that cuff inflation systematically triggers transient EEG arousals rather than full awakenings. Future work will investigate post-arousal blood pressure elevation and heart rate variability changes to further elucidate the cardiovascular consequences of cuff-induced sleep disruption.