Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008

Longitudinal study of the relationship between sleep duration and hypertension in Chinese adult residents (CHNS 2004-2011)

OBJECTIVE

To determine the associations between sleep duration and hypertension in Chinese adults.

METHODS

This longitudinal study analyzed 9851 adults who had participated in at least two rounds of the CHNS (China Health and Nutrition Survey) during 2004-2011. Sleep duration was classified into ≤7, 8, and ≥9 h. Age, sex, residence location, education level, smoking, drinking alcohol, drinking tea, drinking coffee, activity level, and body mass index were adjusted as confounders in a generalized linear mixed model.

RESULTS

The unadjusted analysis showed that compared with a normal sleep duration (8 h), the odds ratios (ORs) for those with short (≤7 h) and long (≥9 h) sleep durations were 1.24 and 1.17, respectively (95% confidence intervals [CIs] = 1.14-1.36 and 1.06-1.29). After adjusting for confounding factors, the effect of a short sleep duration on hypertension was still statistically significant, with an OR of 1.13 (95% CI = 1.04-1.24), while a long sleep duration no longer had a statistically significant effect.

CONCLUSIONS

A short sleep duration is an independent risk factor for adult hypertension, whereas a long sleep duration is not in Chinese adults. The prevalence of hypertension should be prevented and controlled by improving the sleep status of adults.

Relationship of sleep duration on workdays and non-workdays with blood pressure components in Chinese hypertensive patients

Objectives: This study aimed to assess the relationship of sleep duration on workdays and non-workdays with BP components [systolic BP (SBP), diastolic (DBP), pulse pressure (PP), and mean arterial pressure (MAP)] among Chinese hypertensive adults. Methods: The study included 3,376 hypertensive patients without antihypertensive treatment. Self-reported sleep durations on workdays and non-workdays were measured by the questionnaire. Multiple linear regression analyses were performed to evaluate the association of sleep duration with BP components. Results: Overall, compared with a sleep duration of 5-9 h, individuals who slept ≥10 h on both workdays and non-workdays were positively correlated with SBP [β (95% CIs) = 3.99 (1.06, 6.93) and 4.33 (1.79, 6.87)] and PP [β (95% CIs) = 3.25 (0.71, 5.79) and 3.05 (0.85, 5.25)], but not with DBP. Moreover, individuals who slept ≥10 h only on non-workdays had higher MAP [β (95% CIs) = 2.30 (0.63, 3.97)]. The stratified analyses showed that subjects with a BMI ≥24 kg/m² in the longer sleep duration group (≥10 h) only on workdays compared to the reference group had higher SBP, DBP and MAP (all P for interaction <0.05). The effect of longer sleep duration on BP components showed no difference in the following subgroups: sex, age, smoking and drinking (all P for interaction >0.05). Conclusion: Compared with a sleep duration of 5-9 h, longer sleep duration (≥10 h) on workdays and non-workdays was associated with high SBP and PP among Chinese hypertensive adults without antihypertensive treatment.

Association between subjective sleep duration on workdays or non-workdays and uncontrolled blood pressure in Southern China

OBJECTIVES

To examine the association between sleep duration on workdays or non-workdays and unsatisfactory blood pressure (BP) control in Southern China.

METHODS

We analyzed 4370 hypertensive patients, including their self-reported sleep duration on workdays or non-workdays and their BP. Unsatisfactory BP control was defined as systolic BP of ≥140 mm Hg or diastolic BP of ≥90 mm Hg. Multivariate logistic regression analyses were performed to evaluate the association between sleep duration and unsatisfactory BP control.

RESULTS

Overall, the multivariable-adjusted odds ratios of unsatisfactory BP control risk were 1.59 (95% confidence interval, 1.14-2.22) for 9-10 hours of sleep on workdays and 1.47 (95% confidence interval, 1.07-2.03) for ≥10 hours of sleep on non-workdays compared with a sleep duration of 5-9 hours. No association between a short sleep duration and unsatisfactory BP control was noted. The association between a longer sleep duration (≥10 hours) and unsatisfactory BP control was more pronounced among women aged 65-70 years, with a body mass index ≥ 24 kg/m².

CONCLUSION

People with hypertension who slept 9-10 hours on workdays and ≥10 hours on non-workdays were more likely to have unsatisfactory BP control compared with those with a sleep duration of 5-9 hours; these associations tended to vary by age, sex, and body mass index. These findings indicate that a longer sleep duration might be a way to predict uncontrolled BP in hypertensive adults.

Sleep Duration and Hypertension: Analysis of > 700,000 Adults by Age and Sex

STUDY OBJECTIVES

The objective of this study was to evaluate the cross-sectional relationship between sleep duration and hypertension in a large, nationally-representative dataset that spans 10 years. This analysis may provide detailed information with high resolution about how sleep duration is related to hypertension and how this differs by demographic group.

METHODS

Data were aggregated from the 2013 Behavioral Risk Factor Surveillance System (n = 433,386) and the combined 2007-2016 National Health Interview Surveys (n = 295,331). These data were collected by the Centers for Disease Control and Prevention from nationally-representative samples. Surveys were combined, and survey-specific weights were used in all analyses. Sleep duration was assessed with the item, "On average, how many hours of sleep do you get in a 24-hour period?" in both surveys. Hypertension was assessed as self-reported history. Covariates were assessed identically in both datasets and included, age (in 5-year groupings), sex, race/ethnicity, and employment status.

RESULTS

In adjusted analyses, compared to 7 hours, increased risk of hypertension was seen among those sleeping ≤ 4 hours (odds ratio [OR] = 1.86, P < .0005), 5 hours (OR = 1.56, P < .0005), 6 hours (OR = 1.27, P < .0005), 9 hours (OR = 1.19, P < .0005), and ≥ 10 hours (OR = 1.41, P < .0005). When stratified by age, sex, and race/ethnicity groups, short sleep was associated with increased risk for all age groups < 70 years, and long sleep (≥ 10 hours only) was associated with risk for all except < 24 years and > 74 years. Findings for short sleep were relatively consistent across all race/ethnicities, although findings for long sleep were less pronounced among Black/African-American and Other/Multiracial groups. A significant sleep by 3-way sleep × age × sex interaction (P < .0005) suggests that the relationship depends on both age and sex. For both men and women, the OR of having hypertension associated with short sleep decreases with increasing age, but there is a higher association between short sleep and hypertension for women, throughout the adult lifespan.

CONCLUSIONS

Both short and long sleep duration are associated with increased hypertension risk across most age groups. The influence of covariates is stronger upon long sleep relationships. Relationships with short sleep were stronger among younger adults and women.

Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis

Regular physical activity (PA) is important for people with rheumatoid arthritis (RA). Poor sleep is a common complaint among people with RA, which may have an influence on their PA levels. There is a lack of objective information regarding total sleep time (TST) and PA duration in this population. A cross-sectional study design was used. SenseWear Pro3 Armband^(R)TM is used to measure TST and total PA duration. Four valid days, with 95% wear time necessary for inclusion in final results. Disease activity and function were measured using the DAS-28, HAQ and VAS. Data analysis carried out using SPSS v22. Seventy-five (75) participants completed monitoring period, with 51 (68%) meeting modified PA duration guidelines. Data with 95% wear time over a minimum of 4 days were available for 32 recorded participants, with a mean TST of 5.7 (SD_1.11) hours per night and a median 1.25 (IQR_1.88) hours of daily PA. TST had a positive significant relationship with PA (p = 0.018); PA demonstrated a negative significant relationship with functional limitations (p = 0.009) and correlated with lower CRP levels; CRP levels had in turn a significant relationship to global health (p = 0.034). Total sleep time was low for people with RA. People with RA who are more physically active have longer TST. These findings provide an objective profile of TST and PA duration in people with RA and suggest a relationship between increased PA duration and longer TST. Further research is needed to confirm these novel findings.

Subjective sleep quality, blood pressure, and hypertension: a meta-analysis

Sleep quality is an important aspect of sleep, but no meta-analysis has elucidated its relationship with blood pressure (BP) and hypertension. A meta-analysis was conducted in October 2016 using multiple databases, including Embase and Medline. Studies that assessed subjective sleep quality and BP or hypertension were included. Upon full-text evaluation, 29 articles from 45 041 patients were selected, of which 22 articles were included in the meta-analysis and seven were presented narratively. Poor sleep quality was significantly associated with a greater likelihood of hypertension (odds ratio, 1.48; P value = .01). Poor sleepers had higher average systolic BP (mean difference = 4.37, P value = .09) and diastolic BP (mean difference = 1.25, P value = .32) than normal sleepers without statistical significance. Patients with hypertension had significantly worse sleep quality scores (mean difference = 1.51, P value < .01), while BP dippers had significantly better scores (mean difference = -1.67, P value < .01). The findings highlight the relationship between sleep quality and hypertension.

An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices

BACKGROUND

Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality.

OBJECTIVES

The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices.

METHODS

We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures.

RESULTS

With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤0.40) were more frequently males (odds ratio [OR]_{female vs male}=0.45, 95% CI 0.38-0.54), younger individuals (OR_{>60 years vs 18-30 years}=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR_{>78 bpm vs ≤61 bpm}=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR_{>133 mm Hg vs ≤116 mm Hg}=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively.

CONCLUSIONS

Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits.

The effect of sleep duration and sleep quality on hypertension in middle-aged and older Chinese: the Dongfeng-Tongji Cohort Study

OBJECTIVE

To examine the independent and combined associations of sleep duration and sleep quality with hypertension in a middle-aged and older Chinese population.

METHODS

We included 21,912 individuals aged 62.2 years at baseline from September 2008 to June 2010, and they were followed until October 2013. Sleep duration was self-reported and sleep quality was evaluated with questions designed according to the Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure ≥140/90 mmHg, or self-reported physician diagnosis of hypertension, or self-reported current use of antihypertensive medication.

RESULTS

In the cross-sectional analyses, the odds ratio of hypertension prevalence was significantly elevated (OR = 1.13, 95% CI = 1.03-1.24) in those who slept less than 7 h after adjusting for sex, age, body mass index, midday napping, cigarette smoking and sleep quality. It was particularly evident among males (OR = 1.19, 95% CI = 1.01-1.40) and individuals who were thin (OR = 2.00, 95% CI = 1.01-3.93) with full adjustment. The association was also found for sleep duration of 9∼<10 h after adjusting various covariates (OR = 1.14, 95% CI = 1.04-1.27). In addition, impaired sleep quality was only associated with hypertension in obese individuals (OR = 1.25, 95% CI = 1.02-1.50), not in other subgroups. However, no significant association was detected in any category of sleep duration or sleep quality in all models in the prospective analyses, and the results remained unchanged in the subgroup analyses of sex, age and body mass index.

CONCLUSIONS

The results of this study provide limited support for association of sleep duration and sleep quality with hypertension in middle-aged and older Chinese. Further studies are needed to confirm the results.

Association between sleep difficulties as well as duration and hypertension: is BMI a mediator?

Sleep difficulties and short sleep duration have been associated with hypertension. Though body mass index (BMI) may be a mediator variable, the mediation effect has not been defined. We aimed to assess the association between sleep duration and sleep difficulties with hypertension, to determine if BMI is a mediator variable, and to quantify the mediation effect. We conducted a mediation analysis and calculated prevalence ratios with 95% confidence intervals. The exposure variables were sleep duration and sleep difficulties, and the outcome was hypertension. Sleep difficulties were statistically significantly associated with a 43% higher prevalence of hypertension in multivariable analyses; results were not statistically significant for sleep duration. In these analyses, and in sex-specific subgroup analyses, we found no strong evidence that BMI mediated the association between sleep indices and risk of hypertension. Our findings suggest that BMI does not appear to mediate the association between sleep patterns and hypertension. These results highlight the need to further study the mechanisms underlying the relationship between sleep patterns and cardiovascular risk factors.

Hypertension in Cameroon associated with high likelihood of obstructive sleep apnea: a pilot study

BACKGROUND

Although disordered sleep patterns predispose to hypertension (HTN), little is known on the effect of the latter on sleep patterns in sub-Saharan Africa. This study therefore sought to generate preliminary data on the likelihood (risk) of Obstructive sleep apnea (OSA) in hypertensive patients, with the aid of sleep questionnaires.

METHODS

This case-control study, age-and-sex-matched HTN patients with normotensive participants, and compared sleep patterns in either group determined with the aid of the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS).

RESULTS

Overall, 50 HTN and 54 age- and sex-matched normotensive participants were enrolled. The prevalence of snoring was higher in participants with hypertension compared to normotensives (58.0% versus 44.0% respectively), though not significantly, (p = 0.167). However, the hypertensive cases (aged on average 54.78 ± 8.79 years and with mean duration since diagnosis of 4.46 ± 4.36 years) had a significantly higher likelihood of Obstructive Sleep Apnea (OSA) than the controls (aOR = 5.03; 95% CI, 1.90-13.33, p = 0.001) and but no significant resulting daytime sleepiness (p = 0.421). There was no clear trend observed between both the risk of OSA and daytime sleepiness and HTN severity. Although not significant, participants with controlled hypertension had lower rates of risk of OSA compared to those with uncontrolled HTN (50.0% versus 63.2%, p = 0.718).

CONCLUSIONS

Preliminary findings of this study (the first of its kind in Cameroon) suggests that hypertension is positively associated with likelihood of OSA in Cameroon. Further studies are required to investigate this further and the role of sleep questionnaires in our setting, cheap and easy to use tools which can be used to identify early, patients with hypertension in need for further sleep investigations. This will contribute to improving their quality of life and adherence to anti-hypertension treatment.

Sitting Time, Physical Activity and Sleep by Work Type and Pattern-The Australian Longitudinal Study on Women's Health

Data from the Australian Longitudinal Study on Women's Health were used to examine how work was associated with time spent sleeping, sitting and in physical activity (PA), in working women. Young (31-36 years; 2009) and mid-aged (59-64 years; 2010) women reported sleep (categorised as shorter ≤6 h/day and longer ≥8 h/day) and sitting time (work, transport, television, non-work computer, and other; summed for total sitting time) on the most recent work and non-work day; and moderate and vigorous PA (categorised as meeting/not meeting guidelines) in the previous week. Participants reported occupation (manager/professional; clerical/sales; trades/transport/labourer), work hours (part-time; full-time) and work pattern (shift/night; not shift/night). The odds of shorter sleep on work days was higher in both cohorts for women who worked shift or night hours. Longer sitting time on work days, made up primarily of sitting for work, was found for managers/professionals, clerical/sales and full-time workers. In the young cohort, clerical/sales workers and in the mid-aged cohort, full-time workers were less likely to meet PA guidelines. These results suggest multiple behaviour interventions tailored to work patterns and occupational category may be useful to improve the sleep, sitting and activity of working women.

Association of Sleep Duration, Sleep Quality and Shift-Work Schedule in Relation to Hypertension Prevalence in Chinese Adult Males: A Cross-Sectional Survey

Background: Previous studies indicated that measurement of sleep only by duration and quality may be biased. This study aimed to investigate the interactive association of self-reported sleep duration, quality and shift-work schedule with hypertension prevalence in Chinese adult males. Methods: A total of 4519 Chinese adult males (≥18 years) were enrolled into the cross-sectional survey. Sleep attributes were measured from the responses to the standard Pittsburgh Sleep Quality Index and relevant questions in a structured questionnaire survey. The association of sleep duration, quality and shift-work schedule with hypertension prevalence was analyzed using multivariate logistic regression, considering the interaction between them or not. Results: Taking the potential interaction of the three aspects of sleep into consideration, only short sleep duration combined with poor sleep quality was found to be related to hypertension prevalence in Chinese adult males (odds ratio (OR): 1.74, 95% confidence interval (CI): 1.31–2.31), which could be modified by occasional and frequent shift-work schedule (OR: 1.43, 95% CI: 1.05–1.95; OR: 1.97, 95% CI: 1.40–2.79). Conclusions: Short sleep duration was not associated with the prevalence of hypertension in Chinese adult males unless poor sleep quality exists, which could be further modified by shift-work schedule. Assessment of sleep by measuring sleep duration only was not sufficient when exploring the association of sleep with hypertension.

The relationship between hypertension and nocturnal waking in community-dwelling elderly individuals

AIM

This study aimed to clarify the relationship between hypertension and nocturnal waking among community-dwelling elderly individuals.

SUBJECTS AND METHODS

The survey was performed by asking questions related to the basic attributes, lifestyle, sleep conditions and the health status of 422 elderly individuals who belonged to elderly clubs. The subjects were divided into a hypertension group and a non-hypertension group. The data were analyzed using Spearman's rank correlation coefficient and a logistic regression analysis.

RESULTS

Two hundred of the 422 elderly individuals responded to the questions (response rate: 47.4%). The rate of obesity in the hypertension group was significantly higher (p=.01) than that in the non-hypertension group. The logistic regression analysis revealed that hypertension was associated with the BMI (OR=1.148, 95%CI: 1.022-1.289) and the number of nocturnal waking episodes (OR=1.449, 95%CI: 1.015-2.067). In the hypertension group, the number of nocturnal waking episodes was significantly correlated with age (rs=0.232), and the performance of volunteer activities was associated with a decreased number of nocturnal waking episodes (rs=-0.356).

CONCLUSIONS

It was shown that nocturnal waking and obesity were strongly associated with hypertension. The performance of volunteer activities was also correlated a decrease in the number of nocturnal waking episodes. Further studies should be performed to investigate the relationship between hypertension, the number of nocturnal waking episodes and sympathetic nerve activity. A greater number of physiological activities should be evaluated and the volunteer activities in which the elderly people participated should be precisely analyzed.

Assessment of Sleep Quality and Effects of Relaxation Exercise on Sleep Quality in Patients Hospitalized in Internal Medicine Services in a University Hospital: The Effect of Relaxation Exercises in Patients Hospitalized

This study aims to assess sleep quality and determine the effects of relaxation exercise on sleep quality in patients hospitalized in internal medicine services. In total, 47 patients comprised the control group and did not engage in the exercise intervention--the progressive muscle relaxation exercise, whereas 235 patients were assigned to the intervention group (N = 282). In this study, Description Questionnaire Form and the Pittsburg Sleep Quality Index (PSQI) were used. Most patients (73.8%) had poor sleep quality. The mean pre- and postexercise PSQI scores of the patients in the interventional group were 8.7 ± 4.0 and 6.1 ± 3.3, respectively. The mean pre- and postexercise PSQI scores of the control patients were 6.6 ± 3.5 and 5.6 ± 2.7, respectively. According to this study, the exercises significantly enhanced the quality of sleep. Patients should be encouraged by nurses to perform relaxation exercises.

Associations of Self-Reported Sleep Quality with Circulating Interferon Gamma-Inducible Protein 10, Interleukin 6, and High-Sensitivity C-Reactive Protein in Healthy Menopausal Women

Introduction

Sleep disturbance is very common in menopausal women and poor sleep quality has been linked to systemic inflammation. However, the impact of poor sleep quality on health outcomes of menopausal women remains unclear. This study evaluated the relationships between sleep quality and inflammation in menopausal women.

Participants and design

This cross-sectional study enrolled 281 healthy women aged 45 to 60 years. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality of sleep. Multiplex assays were used to measure the levels of 9 cytokines in morning fasting plasma samples. Other variables measured in this study included clinical characteristics and high-sensitivity C-reactive protein (hs-CRP).

Setting

The study was performed at a medical center.

Results

The 281 participants comprised 79 (28%) perimenopausal women and 202 (72%) postmenopausal women. Global PSQI scores were positively correlated with plasma hs-CRP levels (P = 0.012) and were marginally associated with interferon gamma-inducible protein-10 (IP10), interleukin 6 (IL6), and macrophage inflammatory protein-1beta (MIP-1β) levels. After adjusting for age, body mass index, menopause duration, and follicle stimulating hormone, multiple linear regression analysis revealed that high PSQI scores and sleep efficiency < 65% were associated with elevated plasma levels of hs-CRP, IP10, and IL6. In addition, sleep duration < 5 hours was associated with high hs-CRP levels.

Conclusion

Our data show that poor sleep quality and low sleep efficiency are associated with elevated levels of circulating inflammatory factors IP10, IL6 and hs-CRP and that short sleep duration is associated with high levels of hs-CRP in menopausal women. These findings provide novel evidence that poor sleep quality is linked to low-grade systemic inflammation in menopausal women.

Screen Hours and Sleep Symptoms: The US National Health and Nutrition Examination Survey

Few studies have examined the relationship between television viewing, computer use, and sleep symptoms. We hypothesized that television and computer time was associated with sleep symptoms. Screen hours were the sum of daily TV hours and computer hours. A total of 4342 participants 20 years and older had data on screen hours. After adjusting for confounders, 4 or more screen hours were significantly associated with increased odds of reporting long sleep latency, nighttime awakening, high sleep hours, and snoring (P < .05). These findings suggest that increased screen/TV time is an important risk factor for sleep symptoms.

Sleep, insomnia, and hypertension: current findings and future directions

Blood pressure (BP) varies over 24 hours. During normal sleep, BP typically decreases by 10% or more. Research suggests that disordered sleep, particularly sleep deprivation and obstructive sleep apnea, is associated with increased BP and risk of hypertension. Less is known about the relationship between insomnia and hypertension. Population-based studies have reported an association between insomnia symptoms and both prevalent and incident hypertension, particularly in the context of short sleep duration. Furthermore, a number of mechanisms have been proposed to explain the relationship between insomnia and hypertension. However, few studies have examined these proposed mechanisms, and even fewer clinical trials have been conducted to determine if improved sleep improves BP and/or reverses a nondipping BP pattern. Methodological concerns, particularly with respect to the diagnosis of insomnia, no doubt impact the strength of any observed association. Additionally, a large majority of studies have only examined the association between insomnia symptoms and clinic BP. Therefore, future research needs to focus on careful consideration of the diagnostic criteria for insomnia, as well as inclusion of either home BP or ambulatory BP monitoring. Finally, clinical trials aimed at improving the quality of sleep should be conducted to determine if improved sleep impacts 24-hour BP.

Reliability and Validity of the Pittsburgh Sleep Quality Index-Serbian Translation

The aim of this study was translating and exploring psychometric properties of Serbian Pittsburgh Sleep Quality Index (PSQI) in a sample of “good” and “bad” sleepers suffering from depression or obstructive sleep apnea (OSA). Formal translation and validation were performed on a sample of healthy controls, patients with untreated OSA, and with diagnosed major depressive disorder with evaluation of internal consistency, test–retest reliability, and construct and criterion validity. Controls and OSA subgroups were recruited from a larger sample of commercial drivers. One hundred and forty subjects, 84.3% male, 22–67 years old, were included. OSA subgroup had 59 subjects and depression subgroup had 40 subjects (22 females). Mean ± SD total PSQI was 3.5 ± 2.2 in controls, 4.9 ± 3.6 in OSA subjects, and 9.0 ± 4.9 in patients with depression. Cronbach’s α for total PSQI was 0.791. Subscale scores were significantly correlated to global PSQI in all subgroups. Intraclass correlation coefficient for global PSQI was 0.997 ( p < .001). Epworth Sleepiness Scale score was significantly correlated to global PSQI (ρ = 0.333, p < .001). Three subgroups differed significantly in total PSQI and PSQI ≥ 5, even after adjustments for age and gender ( p < .001). OSA patients had higher mean PSQI than controls but not significantly ( p = .272). PSQI-reported sleep latency did not correlate with PSG-measured sleep latency ( r = .130, p = .204). Total PSQI was significantly correlated to OSA severity (ρ = 0.261, p < .05). Serbian PSQI showed good internal consistency, test–retest reproducibility, and adequate construct and criterion validity, which supports further exploration of its use as a sleep quality screening tool in different target populations.

Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample

BACKGROUND

Short sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity.

METHODS

We examined various aspects of sleep in relation to adiposity in 2005-2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression (N = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass.

RESULTS

Snoring was associated with higher BMI (adjusted difference in kg/m² comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted.

CONCLUSION

In a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.

Predictors of Increased Daytime Sleepiness in Patients with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Background. Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from increased daytime sleepiness. The aim of this study was to identify potential predictors of subjective daytime sleepiness with special regard to sleep-related breathing disorder and nocturnal activity. Methods. COPD patients were recruited at the University Hospital Basel, Switzerland. COPD risk groups A-D were determined according to spirometry and COPD Assessment Test (CAT). Breathing disorder evaluation was performed with the ApneaLink device. Nocturnal energy expenditure was measured with the SenseWear Mini Armband. Subjective daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS). Results. Twenty-two patients (36%) were in COPD risk group A, 28 patients (45%) in risk group B, and 12 patients (19%) in risk groups C + D (n = 62). Eleven patients (18%) had a pathological ESS ≥ 10/24. ESS correlated positively with CAT (r = 0.386, p < 0.01) and inversely with age (r = -0.347, p < 0.01). In multiple linear regression age (β = -0.254, p < 0.05), AHI (β = 0.287, p < 0.05) and CAT score (β = 0.380, p < 0.01) were independent predictors of ESS, while nocturnal energy expenditure showed no significant association (p = 0.619). Conclusion. These findings provide evidence that daytime sleepiness in COPD patients may partly be attributable to nocturnal respiratory disturbances and it seems to mostly affect younger patients with more severe COPD symptoms.

Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents

OBJECTIVE

Sleep disordered breathing (SDB) has not been well studied in urban adolescents with asthma in community settings. Nor has the association of SDB symptoms and asthma severity been studied. We characterized self-reported symptoms suggesting SDB and investigated the association of SDB symptoms, probable asthma, and asthma severity.

METHODS

9,565 adolescents from 21 inner-city high schools were screened for an asthma intervention study. Students reported on symptoms suggesting SDB using questions from the 2007 NHANES, if they were ever diagnosed with asthma, and on asthma symptoms. Using generalized linear mixed models with logit link with school as a random intercept and adjusting for age, gender, and race/ethnicity, we examined associations of SDB symptoms, and demographic characteristics, probable asthma, and asthma severity.

RESULTS

12% reported SDB symptoms. Older and bi-racial participants (compared to Caucasian) had higher odds of symptoms suggesting SDB (p <.001). Compared to those without probable asthma, adolescents with probable asthma had 2.63 greater odds of reporting SDB symptoms (p <.001). Among those with probable asthma, the odds of reporting SDB symptoms increased with asthma severity. When exploring daytime severity and severity due to night wakening separately, results were similar. All results remained significant when controlling for age, gender, and ethnicity.

CONCLUSIONS

In a large urban community cohort of predominately ethnic minority adolescents, self-reported SDB symptoms were associated with probable asthma and increased asthma severity. This study highlights the importance of SDB as a modifiable co-morbidity of asthma.

Free-living cross-comparison of two wearable monitors for sleep and physical activity in healthy young adults

There is a growing need for free-living monitoring of the full 24 h spectrum of behaviors with a single or integrated set of sensors. The validity of field standard wearable monitors in sleep and physical activity have yet to be assessed for the complementary behavior in the context of 24 h continuous monitoring. We conducted a free-living comparison study of the Actigraph GT3X+ (GT3X+) to assess sleep parameters as compared with the Actiwatch-64 (AW-64) and concurrently, the AW-64 to assess sedentary and physical activity behaviors as compared with the GT3X+. Thirty young adults (15 female, 19.2±0.86 years) wore both monitors for 3 consecutive days and 2 consecutive nights. Agreement of sleep, sedentary, and physical activity metrics were evaluated using analyses of variance, intraclass correlation coefficients, Bland-Altman plots with associated confidence limits, mean absolute percentage of errors and equivalence tests. For sleep, the GT3X+ showed high agreement for total sleep time and sleep efficiency, but underestimated wakefulness after sleep onset and sleep onset latency relative to the AW-64. For sedentary behavior and physical activity, the AW-64 showed a moderate agreement for activity energy expenditure, but not for sedentary, light or moderate-vigorous physical activities relative to the GT3X+. Overall our results showed good agreement of the GT3X+ with AW-64 for assessing sleep but a lack of agreement between AW-64 and GT3X+ for physical activity and sedentary behaviors. These results are likely due to the monitor placement (wrist vs hip), as well as the algorithm employed to score the data. Future validation work of existing and emerging technologies that may hold promise for 24 h continuous monitoring is needed.

Sleep Quality and Associated Factors in Older Turkish Adults With Hypertension: A Pilot Study

PURPOSE

The purpose of this study was to evaluate sleep quality and to explore its associations with participant characteristics, anemia, excessive daytime sleepiness, and physical activity in older Turkish adults with hypertension.

METHOD

This cross-sectional study included 128 adults aged 60 years or older with hypertension. Data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the International Physical Activity Questionnaire. Anemia was assessed by hemoglobin levels.

RESULTS

Eighty-one patients (63.3%) reported poor sleep quality. Anemia was present in 35.2% of the patients (defined as hemoglobin <13 g/dL for males and <12 g/dL for females). Female gender, the presence of anemia, and low levels of physical activity were associated with poor sleep quality. Conclusion/Implication: The majority of the participants had poor sleep quality. Better understanding of risk factors associated with poor sleep quality may contribute to more effective interventions to improve health and well-being.

Prevalence of self-reported sleep duration and sleep habits in type 2 diabetes patients in South Trinidad

The present study aims to determine the prevalence of self-reported sleep duration and sleep habits and their associated factors in patients with type 2 diabetes in Trinidad. This was a cross-sectional multicenter study. There were 291 patients with type 2 diabetes studied. Sleep habits were assessed using the Epworth Sleepiness Scale (ESS) and the National Health and Nutrition Examination Survey sleep disorder questionnaire. Demographic, anthropometric and biochemical data were also collected. The sample had a mean age of 58.8 years; 66.7% were female. The mean BMI was 28.9 kg/m(2). The prevalence of Excessive Daytime Sleepiness (EDS) was 11.3%. The prevalence of patients with short sleep (⩽6h) was 28.5%. The prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. There needs to be an increased awareness of sleep conditions in adults with type 2 diabetes by doctors caring for these patients.

Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach

The associations between time spent in sleep, sedentary behaviors (SB) and physical activity with health are usually studied without taking into account that time is finite during the day, so time spent in each of these behaviors are codependent. Therefore, little is known about the combined effect of time spent in sleep, SB and physical activity, that together constitute a composite whole, on obesity and cardio-metabolic health markers. Cross-sectional analysis of NHANES 2005–6 cycle on N = 1937 adults, was undertaken using a compositional analysis paradigm, which accounts for this intrinsic codependence. Time spent in SB, light intensity (LIPA) and moderate to vigorous activity (MVPA) was determined from accelerometry and combined with self-reported sleep time to obtain the 24 hour time budget composition. The distribution of time spent in sleep, SB, LIPA and MVPA is significantly associated with BMI, waist circumference, triglycerides, plasma glucose, plasma insulin (all p<0.001), and systolic (p<0.001) and diastolic blood pressure (p<0.003), but not HDL or LDL. Within the composition, the strongest positive effect is found for the proportion of time spent in MVPA. Strikingly, the effects of MVPA replacing another behavior and of MVPA being displaced by another behavior are asymmetric. For example, re-allocating 10 minutes of SB to MVPA was associated with a lower waist circumference by 0.001% but if 10 minutes of MVPA is displaced by SB this was associated with a 0.84% higher waist circumference. The proportion of time spent in LIPA and SB were detrimentally associated with obesity and cardiovascular disease markers, but the association with SB was stronger. For diabetes risk markers, replacing SB with LIPA was associated with more favorable outcomes. Time spent in MVPA is an important target for intervention and preventing transfer of time from LIPA to SB might lessen the negative effects of physical inactivity.

Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions

OBJECTIVES

For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA).

METHODS

An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward.

RESULTS

The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA.

CONCLUSIONS

Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.

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

OBJECTIVES

Epidemiologic studies have shown that chronic short sleep may be associated with the development of hypertension; however, the results are controversial. This meta-analysis was conducted to determine whether the duration of sleep is associated with hypertension.

METHODS

Reference databases (PubMed, EmBase, the Cochrane Library, Chinese Biological Medicine database) were searched for studies related to sleep duration and hypertension. Sleep duration categories (≤ 5 h, 6 h, 7 h, 8 h, ≥ 9 h) and prevalence or incidence of hypertension in each sleep category were extracted. A general analysis and subgroup analyses stratified by gender, age, study design, and different definitions of sleep duration were conducted to evaluate the relationship between sleep duration and hypertension.

RESULTS

Thirteen articles out of a total of 1,628 articles involving 347,759 participants met the inclusion criteria. A U-shaped change in pooled odds ratios (ORs) for hypertension due to the change of sleep duration was observed. The unadjusted OR for hypertension of individuals who slept ≤ 5 h vs. 7 h was 1.61, 95% CI = 1.28-2.02; those who slept ≥ 9 h vs. 7 h was 1.29, 95% CI = 0.97-1.71. The pooled ORs were still significant after adjusted by age and gender. Women deprived of sleep (sleep time ≤ 5 h vs. 7 h, OR = 1.68, 95% CI = 1.39-2.03) had a higher risk of hypertension than men (OR = 1.30, 95% CI = 0.93-1.83).

CONCLUSION

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

Retinal Disorders and Sleep Disorders: Are They Genetically Related?

Introduction

Sleep is important for optimal physical health and vitality. Recent studies have shown that individuals with visual impairments may be at risk for sleep problems. This research examines the prevalence of sleep problems among those with retinal disorders and the possibility of a genetic link.

Methods

Subjects with retinitis pigmentosa ( n = 33), Stargardt's disease ( n = 31) and age-related macular degeneration ( n = 43) were recruited from the ophthalmology department of Montreal Children's Hospital. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Genetic testing was conducted by the Radboud University Medical Center in Nijmegen, Netherlands. Retinal genes were identified as having retina only or pineal and retinal expression.

Results

The expression patterns of genes causing retinal disorders did not predict sleep quality. The PSQI indicated poor sleep quality in 56% of participants with retinitis pigmentosa, 48% of those with Stargardt's disease, and 53% of those with age-related macular degeneration. The ESS showed that daytime sleepiness was experienced by 20% of individuals with retinitis pigmentosa or Stargardt's disease, and by only one individual with age-related macular degeneration.

Discussion

Approximately 50% of people with retinal disease have sleep problems. This number compares with up to one-third of the general population. Gene expression did not correlate with sleep quality, and the explanation for such a large percentage of sleep disorders needs further investigation.

Implications for practitioners

Eye care and rehabilitation specialists need to be aware of the high prevalence of poor sleep quality in individuals with retinal disorders, since this situation may have an important impact on memory and learning, both of which are vital in successful rehabilitation.

Short sleep duration increases the risk of chronic kidney disease in shift workers

OBJECTIVE

To investigate the association of sleep duration and shift work with development of chronic kidney disease (CKD) in Japanese workers.

METHODS

A total of 3600 participants without CKD were observed for an average of 4.4 years. The Cox proportional-hazards regression model was used to estimate hazard ratios and 95% confidence intervals of the risk of CKD associated with sleep duration and shift work.

RESULTS

Sleep duration and shift work showed no significant association with the risk of CKD. Nevertheless, when the results were stratified by shift work status, short sleep duration was associated with a significantly higher risk of CKD among shift workers (hazard ratio = 3.60; 95% confidence interval: 1.52 to 10.68).

CONCLUSIONS

Short sleep duration was a risk factor for early CKD but only among shift workers.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

The relationship between hypertension and sleep duration: an analysis of the fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3)

Introduction

Hypertension is a significant risk factor for cardiovascular disease (CVD). The majority of patients, however, cannot easily maintain a healthy blood pressure. Therefore, lifestyle modifications are important and may include getting enough sleep. The purpose of this study was to determine the relationship between sleep duration and hypertension, as defined by the Joint National Committee (JNC) 7 and JNC 8 guidelines.

Methods

We used the data from 6,365 individuals aged ≥ 18 years based on national data from a representative sample of the 5^th Korea National Health and Nutrition Examination Survey V-3 in 2012. The participants were divided into three categories: JNC 7, JNC 8, and newly excluded only. The duration of sleep was classified as less than 5, 6, 7, 8, or more than 9 hours.

Results

Compared with the appropriate sleep duration of 7 hours, with a sleep duration of less than 5 hours, the recommended pharmacological treatment of hypertension rate increased 1.908-fold (95% CI = 1.483-2.456) according to the JNC 8 guidelines and 1.864-fold (95% CI = 1.446-2.403) according to the JNC 7 guidelines. However, there was no statistical difference with the other sleep categories.

Discussion

The recommended hypertension treatment rate increased significantly in the less than 5 hours sleep group according to the JNC 8 guidelines. To manage hypertension effectively, it may be useful to maintain a lifestyle of sleeping more than 6 hours.

Interaction of Sleep Duration and Sleep Quality on Hypertension Prevalence in Adult Chinese Males

Background

Previous studies demonstrated conflicting results about the association of sleep duration and hypertension. Given the potential relationship between sleep quality and hypertension, this study aimed to investigate the interaction of self-reported sleep duration and sleep quality on hypertension prevalence in adult Chinese males.

Methods

We undertook a cross-sectional analysis of 4144 male subjects. Sleep duration were measured by self-reported average sleep time during the past month. Sleep quality was evaluated using the standard Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure level ≥140/90 mm Hg or current antihypertensive treatment. The association between hypertension prevalence, sleep duration, and sleep quality was analyzed using logistic regression after adjusting for basic cardiovascular characteristics.

Results

Sleep duration shorter than 8 hours was found to be associated with increased hypertension, with odds ratios and 95% confidence intervals (CIs) of 1.25 (95% CI, 1.03–1.52) for 7 hours, 1.41 (95% CI, 1.14–1.73) for 6 hours, and 2.38 (95% CI, 1.81–3.11) for <6 hours. Using very good sleep quality as the reference, good, poor, and very poor sleep quality were associated with hypertension, with odds ratios of 1.20 (95% CI, 1.01–1.42), 1.67 (95% CI, 1.32–2.11), and 2.32 (95% CI, 1.67–3.21), respectively. More importantly, further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated an additive interaction.

Conclusions

There is an additive interaction of poor sleep quality and short sleep duration on hypertension prevalence. More comprehensive measurement of sleep should be performed in future studies.

Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study

STUDY OBJECTIVES

Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men.

SETTING AND PARTICIPANTS

Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study.

INTERVENTIONS

Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods.

RESULTS

16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models.

CONCLUSIONS

Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep.

Association between self-reported global sleep status and prevalence of hypertension in Chinese adults: data from the Kailuan community

BACKGROUND

Assessment of sleep only by sleep duration is not sufficient. This cross-sectional study aimed to investigate the potential association of self-reported global sleep status, which contained both qualitative and quantitative aspects, with hypertension prevalence in Chinese adults.

METHODS

A total of 5461 subjects (4076 of them were male) were enrolled in the current study and were divided into two groups with the age of 45 years as the cut-off value. Sleep status of all subjects was assessed using the standard Pittsburgh Sleep Quality Index (PSQI). Hypertension was defined as blood pressure ≥140/90 mmHg in the current study.

RESULTS

After adjusting for basic cardiovascular characteristics, the results of multivariate logistic regression indicated that sleep status, which was defined as the additive measurement of sleep duration and sleep quality, was associated with hypertension prevalence in males of both age groups (odds ratio (OR) = 1.11, 95% confidence interval (CI), 1.07-1.15, p < 0.05; OR = 1.12, 95% CI, 1.08-1.15, p < 0.05) and in females aged ≤45years (OR = 1.10, 95% CI, 1.02-1.18, p < 0.05). As one component of PSQI, short sleep duration was associated with hypertension prevalence only in Chinese male subjects, but this association disappeared after the further adjustment of the other components of PSQI that measured the qualitative aspect of sleep.

CONCLUSION

Association between sleep status and hypertension prevalence in Chinese adults varied by age and sex. Sleep should be measured qualitatively and quantitatively when investigating its association with hypertension.

Sleep quality and duration are related to microvascular function: the Amsterdam Growth and Health Longitudinal Study

Sleep and sleep disorders are related to cardiovascular disease, and microvascular function is an early cardiovascular disease marker. Therefore, the relationship of sleep (measured in sleep quality and duration) with microvascular function was examined in healthy adults. Sleep quality was assessed with the validated Sleep Wake Experience List (SWEL) questionnaire. Duration of sleep was self-reported in an additional question. Microvascular function was measured using nailfold capillaroscopy. Linear regression analyses were used to examine the relationship between sleep and microvascular function. Potential confounders included physical activity, smoking, blood pressure, body mass index and several biochemical parameters. Analyses were performed in 259 participants (116 men). For women reporting insufficient (<7 h) sleep duration, microvascular function (post-ischaemic capillary recruitment) was significantly lower (b = -11.17; P = 0.04) compared to women reporting sufficient sleep duration. There was no relationship between sleep quality and microvascular function in females. In males, a trend towards lower capillary recruitment was found in those reporting a combination of poor sleep quality and insufficient duration (b = -7.54; P = 0.09), compared to those reporting good sleep quality as well as sufficient duration. This study suggests an association between sleep and microvascular function. Which aspects of sleep exactly affect microvascular function, and if indeed the association is different between males and females in other samples, needs further research.