Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis

Wang, Yan; Mei, Hao; Jiang, Yanrui; Sun, Wanning; Song, Yuxuan; Liu, Shijian; Fan, Jian‐Gao

doi:10.5664/jcsm.5024

Cited by 194 publications

(141 citation statements)

References 72 publications

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“…Sleep deprivation among women (≤5 hours versus 7 hours/night) is associated with a greater risk of hypertension (odds ratio: 1.68, 95% confidence interval, 1.39–2.03) than that observed among men (odds ratio: 1.30; 95% confidence interval, 0.93–1.83); however, only 3 out of 23 reviewed studies presented findings stratified by sex 16, 17, 18, 19. Prolonged sleep onset latency increases the odds of hypertension by 300% (odds ratio: 3.27; 95% confidence interval, 1.20–8.96) 20.…”

Section: Introductionmentioning

confidence: 93%

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

Aggarwal

Makarem

Shah

et al. 2018

JAHA

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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.

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Section: Introductionmentioning

confidence: 93%

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

Aggarwal

Makarem

Shah

et al. 2018

JAHA

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“…90 Recent experiments indicate that a simulated work week with restricted sleep leads to a reduction in insulin sensitivity when early breakfasts are eaten or when timing is shifted. 84 91 Recent meta-analyses including 24 and 13 studies, 92 93 and a systematic review, 94 show that short sleep duration is related to a higher prevalence of hypertension. Some support exists for links between shift work, elevated blood pressure, hypertension, worse blood lipid profile, and blood coagulation, 6 71 as well as for blood lipids being worse in people eating more at night.…”

Section: Behavioural Mechanismsmentioning

confidence: 99%

Health consequences of shift work and insufficient sleep

Kecklund

Axelsson

2016

BMJ

772

631

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This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adverse health. Evidence shows that the effect of shift work on sleep mainly concerns acute sleep loss in connection with night shifts and early morning shifts. A link also exists between shift work and accidents, type 2 diabetes (relative risk range 1.09-1.40), weight gain, coronary heart disease (relative risk 1.23), stroke (relative risk 1.05), and cancer (relative risk range 1.01-1.32), although the original studies showed mixed results. The relations of shift work to cardiometabolic diseases and accidents mimic those with insufficient sleep. Laboratory studies indicate that cardiometabolic stress and cognitive impairments are increased by shift work, as well as by sleep loss. Given that the health and safety consequences of shift work and insufficient sleep are very similar, they are likely to share common mechanisms. However, additional research is needed to determine whether insufficient sleep is a causal pathway for the adverse health effects associated with shift work.

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“…Three recent systematic reviews and meta-analyses of cross-sectional and prospective epidemiologic studies have reported 20%-61% higher hypertension risk with short sleep duration. [16][17][18] In a meta-analysis by Wang et al, 18 However only 3 of the reviewed prospective cohort studies presented findings stratified by sex. [19][20][21] An analysis within the London-based Whitehall II study of 10,308 white-collar British civil servants ages 35-55 years exam-ined both the cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension.…”

Section: Sleep and Cardiometabolic Risk Factorsmentioning

confidence: 99%

Gender Differences in Associations between Insufficient Sleep and Cardiovascular Disease Risk Factors and Endpoints: A Contemporary Review

MakaremNour

AggarwalBrooke

2017

Gender and the Genome

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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States for both men and women. The increasing appreciation of the gender differences in behavioral and physiologic interconnectedness of cardiometabolic risk factors has led to a growing literature evaluating relationships between sleep-an integral part of overall health and a source of physiological resilience-in relation to CVD and its risk factors in male and female cohorts. This article reviews the published research related to gender differences in the role of insufficient sleep in the etiology of CVD. Evidence on gender differences in the associations between sleep and other behavioral risk factors for CVD, namely diet and physical activity, is in the nascent stages of characterization but suggests that insufficient sleep may have a more pronounced detrimental impact on the diets of women. The literature on gender differences in the role of insufficient sleep in inflammation, dyslipidemia, glycemic control and insulin sensitivity, and obesity is inconclusive. Inadequate sleep duration is associated with elevated blood pressure, weight gain, hypertension, and obesity in both men and women, but associations may be stronger among women. Moreover, gender differences may vary by age group. Inflammation resulting from inadequate sleep may also be more pronounced among women. Inconsistent results were observed in studies on dyslipidemia with results ranging from null to detrimental associations in men and from detrimental to protective associations in women. Short sleep is also associated with poor glycemic control among men, with evidence of potential gender differences in associations with insulin sensitivity. Finally, insufficient sleep is convincingly associated with CVD etiology, but women appear to be more vulnerable to the effects of poor sleep on CVD risk and mortality. In conclusion, emerging data demonstrate that heterogeneity exists between men and women in how sleep duration influences behavioral and cardiometabolic risk factors in addition to CVD risk and mortality, but additional research is warranted to clarify associations and disentangle underlying mechanisms. In an era of genomics and personalized medicine, studying gender differences in the role of sleep in the risk for cardiometabolic disease is crucial for identifying innovative targets and tailoring public health interventions to focus on the most vulnerable population groups.

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Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis

Abstract: Excessively longer and shorter periods of sleep may both be risk factors for high blood pressure; these associations are stronger in women than men.

Cited by 194 publications

References 72 publications

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

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

Health consequences of shift work and insufficient sleep

Gender Differences in Associations between Insufficient Sleep and Cardiovascular Disease Risk Factors and Endpoints: A Contemporary Review

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