Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Abstract

BackgroundInsufficient sleep increases blood pressure. However, the effects of milder, highly prevalent but frequently neglected sleep disturbances, including poor sleep quality and insomnia, on vascular health in women are unclear. We investigated whether poor sleep patterns are associated with blood pressure and endothelial inflammation in a diverse sample of women.Methods and ResultsWomen who participated in the ongoing American Heart Association Go Red for Women Strategically Focused Research Network were studied (n=323, 57% minority, mean age=39±17 years, range=20–79 years). Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index (score ≥5=poor sleep quality). Risk for obstructive sleep apnea was evaluated using the Berlin questionnaire, and insomnia was assessed using the Insomnia Severity Index. In a subset of women who participated in the basic study (n=26), sleep duration was assessed objectively using actigraphy, and endothelial inflammation was assessed directly in harvested endothelial cells by measuring nuclear translocation of nuclear factor kappa B. Vascular reactivity was measured by brachial artery flow‐mediated dilation (n=26). Systolic and diastolic blood pressure were measured by trained personnel (n=323). Multivariable linear regressions were used to evaluate associations between sleep patterns and blood pressure, nuclear factor kappa B, and flow‐mediated dilation. Mean sleep duration was 6.8±1.3 hours/night in the population study and 7.5±1.1 hour/night in the basic study. In the population study sample, 50% had poor sleep quality versus 23% in the basic study, and 37% had some level of insomnia versus 15% in the basic study. Systolic blood pressure was associated directly with poor sleep quality, and diastolic blood pressure was of borderline significance with obstructive sleep apnea risk after adjusting for confounders (P=0.04 and P=0.08, respectively). Poor sleep quality was associated with endothelial nuclear factor kappa B activation (β=30.6; P=0.03). Insomnia and longer sleep onset latency were also associated with endothelial nuclear factor kappa B activation (β=27.6; P=0.002 and β=8.26; P=0.02, respectively). No evidence was found for an association between sleep and flow‐mediated dilation.ConclusionsThese findings provide direct evidence that common but frequently neglected sleep disturbances such as poor sleep quality and insomnia are associated with increased blood pressure and vascular inflammation even in the absence of inadequate sleep duration in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02835261.

Double the Prevalence of Stage 2 Hypertension Readings in a Small Group of American Pre-clinical Medical Students Compared to Young Adults Diagnosed with Stage 2 Hypertension in the United States

“…In this study, we found that students who sleep less than six hours per night are at significant risk of developing elevated, stage 1 HTN, and stage 2 HTN. Studies have shown that inadequate sleep and poor sleep quality are associated with increased blood pressure [16][17]. In our study, 25.5% (54/212) of students sleep an average of 6 hours or less per night, and we believe that the issue of sleep deprivation is prevalent in other medical schools.…”

“…The mean age of the sample was 25.8 years (SD = 2.75 years) and the range was between 21 and 37 years. Under the 2017 ACC/AHA guidelines, 36.6% (78/213) were normotensive; 16.4% (35/213) had elevated blood pressure; 29.1% (62/213) had stage 1 HTN; and 17.8% (38/213) had stage 2 HTN. A multinomial logistic regression model was significant, χ 2 (9) = 82.934, p < 0.001, explained 34.9% (Nagelkerke R 2 ) of the variance in HTN, and correctly classified 50.2% of cases.…”

A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network

“…Green leafy vegetables are also a rich source of nitrates that convert to nitric oxide when consumed; the Mediterranean diet contains significantly higher amounts of nitrate than the typical Western diet [42]. Reduced nitric oxide bioavailability may contribute to endothelial dysfunction [43], which has been linked to poor sleep in women [44]. Similarly, legumes are often rich in the amino acid tryptophan, which is a precursor for melatonin.…”

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

“…According to PSG measurements, patients in the study group had decreased sleep duration (total sleep time) and slow wave sleep (SWS), increased wake time after sleep onset and sleep fragmentation. Short sleep duration and sleep fragmentation are related to sympathetic excitation, 25 high blood pressure, 26 vascular endothelial inflammation 27 and endothelial injury, 28 while decrease in SWS could lead to abnormal immune regulation in view of its importance in adaptive immune memory. 29 Based on these results, it is reasonable to assume that changes in sleep characteristics of CSVD patients contribute to the abnormal inflammatory response.…”