Association between sleep duration and hypertension among Chinese children and adolescents

Sleep Duration and Blood Pressure in Youth Referred for Elevated Blood Pressure Evaluation

OBJECTIVES

Sleep promotion is not specifically recommended as a target for hypertension management. We examined associations of sleep duration and timing with blood pressure parameters in patients referred to pediatric nephrology clinic for elevated blood pressure evaluation.

METHODS

This is a retrospective study of initial ambulatory blood pressure monitoring data and self-report sleep data collected from patients referred to nephrology clinic for the evaluation of elevated blood pressure. Linear and logistic regression modeling determined associations between sleep exposures (duration and timing) and continuous and dichotomous blood pressure outcomes, respectively, adjusted for age, sex, body mass index, and weekday versus weekend status.

RESULTS

The study sample included 539 patients with mean age 14.6 years and 56% meeting hypertension criteria. Sleep duration averaged 9.1 hours per night. Average timing of sleep onset and offset were 11:06 pm and 8:18 am, respectively. Longer sleep duration was associated with better daytime blood pressure parameters (eg, every extra hour of sleep duration was associated with a reduced odds of wake hypertension [odds ratio, 0.88; 95% CI, 0.79-0.99]). Later sleep onset was associated with worse daytime blood pressure parameters (eg, each additional hour of later sleep onset was associated with higher wake systolic blood pressure index [mean wake blood pressure/95th percentile]) (β = 0.07; 95% CI, 0.02-0.13). Associations were consistent across sex, age, body mass index, and weekday status.

CONCLUSIONS

Longer sleep duration and earlier sleep onset were associated with lower blood pressure. This suggests that sleep optimization may be an important target for intervention in hypertension management.

The impact of dietary and sleep rhythms on blood pressure in children and adolescents: a cross-sectional study

Evidence about the relationship between meal and sleep time and CVD in children is scarce. The aims of this study were to describe the association between life rhythm patterns and blood pressure in children. This research was conducted among 5,608 children aged 6 to 15 years old in Chongqing and Sichuan provinces in 2021 and 2022. Dietary and sleep rhythms information was collected. The time of the first meal and last meal, and sleep time, were obtained. The mean age was 10.48 ± 2.24 years old, with 2958 (52.75%) male participants. The mean feeding window on weekdays was 11.69 h, 12.42 h, and 13.23 h for participants aged 6-7 years old, 8-12 years old and 13-15 years old, respectively. Weekday feeding window and last mealtime were positively correlated with blood pressure levels. And the changes in the feeding window between weekdays and weekends were significantly correlated with BP. Sleep duration and change in wake time were significantly correlated with SBP. Based on these results, this study identified the optimal combination of dietary and sleep rhythm interventions for children younger than 12 years of age and aged 12 and older, respectively. Disorder dietary and sleep rhythms disorders may correlate with elevated blood pressure levels, suggesting developing optimal dietary and sleep rhythm patterns could prevent the incidence of CVDs in children. The optimal dietary rhythm was defined by the indexes of breakfast time, dinner time and daily feeding window. As good meal patterns are defined as satisfied the following three items: for children younger than 12 years should have breakfast after 7:30 am; aged 12 years and over should have breakfast after 7 am; having dinner before 6 pm; daily feeding window less than 12.5 h. And less optimal dietary rhythm should satisfy any condition or eat dinner between 6 pm and 8 pm; and poor dietary rhythm should not satisfy any of the three criteria and eat dinner after 8 pm. Children with optimal dietary rhythm (in group A) had lower SBP (P < 0.001), DBP (P = 0.002) and MAP (P < 0.001) than those in group C.

Hypertension and Associated Risk Factors among Children with Intellectual Disability: A Cross-Sectional Study

To investigate the prevalence of hypertension and associated risk factors in Chinese children with intellectual disability, a cross-sectional study was conducted in a sample of 558 children with intellectual disability aged 6–18 years in Hong Kong, and 452 (81.0%) with valid data were included in the data analysis. Blood pressure was measured according to a standard protocol. Hypertension was defined using the age-, gender-, and height-specific classification criteria recommended by the 2018 Chinese Guidelines for Children. Multivariate and hierarchical logistic regression was fitted to examine the associations of hypertension with potential risk factors. Overall, 31.4% of the participants were classified as having hypertension. Obese children were more likely to develop hypertension than non-obese children (adjusted OR = 2.77, 95% CI: 1.28, 5.99, p = 0.010). A paternal education of college or above and a paternal occupation of clerks, sales representatives, and workers were also associated with an increased risk of hypertension. The prevalence of hypertension is high among Chinese children with intellectual disability. Obesity was the strongest risk factor. Further longitudinal studies are warranted to confirm our findings. Nevertheless, preventions against obesity are promising to receive doubled benefits in reducing both obesity and hypertension, given its strong relationship with hypertension in this special population.

Association of sleep trajectory in adulthood with risk of hypertension and its related risk factors: the China Health and Nutrition Survey

STUDY OBJECTIVES

Few studies have examined the association between sleep duration trajectories and hypertension. This study aims to examine association of sleep duration trajectories with risk of hypertension and its related factors.

METHODS

This study used longitudinal data for 7,397 adults who provided valid responses in questionnaire with regard to information of sleep and hypertension from the China Health and Nutrition Survey (2004-2011). Subgroup analyses included 5,532 participants in whom hypertension-related factors were measured using blood samples. Latent class trajectory analysis was used to identify different sleep duration trajectories. Multivariate Cox regression models and general linear regression models were used to assess association of trajectories with hypertension and its related factors.

RESULTS

Compared to stable sleep duration around 8 hours, the trajectory showing a persistent decrease in sleep duration with aging was significantly associated with increased risk of hypertension (hazard ratio 1.12, 95% confidence interval 1.01-1.24), whereas no significant association was observed between the trajectory showing an increase in sleep duration to 9 hours with aging and risk of hypertension (hazard ratio 1.05, 95% confidence interval 0.93-1.19). Further, uric acid levels, fasting glucose levels, total cholesterol levels, and apolipoprotein B levels were significantly higher in the trajectory showing a persistent decrease in sleep duration with aging than the other two trajectories (all P < .05).

CONCLUSIONS

Decreasing sleep duration during aging is significantly associated with increased risk of hypertension and higher levels of its biomarkers throughout adulthood.

Sleep Fragmentation and Atherosclerosis: is There a Relationship?

Sleep fragmentation refers to the disruption of sleep architecture with poor quality of sleep despite optimal duration of sleep. Sleep fragmentation has been shown to have multiple effects on different body systems. This article reviews the effect of sleep fragmentation on the rate of atherosclerosis which has been linked to comorbidities like myocardial infarction, stroke, and coronary artery disease with an aim to educate patients regarding the importance of sleep hygiene and to incorporate a good amount and quality of sleep as life style modification along with diet and exercise.

EVIDENCE OF THE ASSOCIATION BETWEEN SLEEP DURATION AND BLOOD PRESSURE IN ADOLESCENTS: A SYSTEMATIC REVIEW

OBJECTIVE

To review the epidemiological evidence of the association between sleep duration and blood pressure in adolescents.

DATA SOURCES

We performed a systematic review of observational studies in Medline, Scopus, Lilacs, Web of Science, Science Direct databases and Virtual Libraries in English, Spanish and Portuguese published until September 2018. Studies were selected first by title and abstract, then by complete reading, according to the eligibility criteria. The reference list of selected articles was evaluated in order to retrieve relevant studies.

DATA SYNTHESIS

Initially, 1,455 articles were retrieved. After exclusion due to duplicity or not meeting the eligibility criteria, 13 articles were included in the review. Studies varied greatly in sample size (143 to 6,940 patients), methods of measuring blood pressure and sleep duration, cutoff points, categorization and adjustment of variables. The main evidence from the studies is that short sleep duration is associated with high blood pressure in adolescence, although the presence of association between high blood pressure and long sleep duration is possible, but not clear in the literature.

CONCLUSIONS

Sleep duration, especially short duration, is associated with high blood pressure in adolescents. Such evidence draws attention to implications on cardiovascular health in this age group.

Gender-Specific Longitudinal Association of Sleep Duration with Blood Pressure among Children: Evidence from CHNS 2004-2015

Purpose

We conducted this study to add the evidence regarding the gender-specific association between sleep duration and blood pressure (BP) in children.

Methods

A secondary analysis was performed among 1000 children aged 7–13 years, who had at least two rounds of survey records in China Health and Nutrition Survey through 2004–2015. Generalized estimating equation was used to explore the gender-specific association of sleep duration with BP. The subgroup analysis was applied in those participants with normal weight.

Results

The time trend of decreasing sleep duration, along with increasing BP level, was observed in each age group during the survey period. Short sleepers (<9 hours per day) have higher level of both systolic BP (SBP) and diastolic BP (DBP) than long sleepers in girls (all p < 0.05). By contrast, only SBP was higher in short sleepers among boys (p < 0.05). There was gender difference in the association between sleep duration and DBP (p for interaction <0.05). The stratification analysis showed that short sleep duration could consistently predict a higher level of diastolic BP (DBP) in both crude (β = 2.968, 95% CI: 1.629, 4.306) and adjusted models (β = 1.844, 95% CI: 0.273, 3.416) only in girls. Sleep duration was also analyzed as continuous variable, and the very similar associations were observed. Moreover, the established associations can be verified among children with normal weight.

Conclusions

There was a time trend of decreasing sleep duration alongside increasing BP among children from 2004 to 2015. Short sleep duration was independently associated with increased DBP; however, only girls were susceptible to the association.

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study

OBJECTIVES

The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6-18 years old.

METHODS

This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the "Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease" (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children ≥ 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale ( never, rarely, weekly, and daily).

RESULTS

In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 [95% CI: 1.38-1.61]; p = .001), soft drinks (OR = 1.12 [95% CI: 1.04-1.20]; p = .002), fast foods (OR = 1.66 [95% CI: 1.54-1.79]; p < .001), tea (OR = 1.49 [95% CI: 1.39-1.61]; p < .001), and tea with sugar (OR = 1.13 [95% CI: 1.05-1.22]; p < .001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 [95% CI: 0.58-0.70]; p < .001), soft beer (OR = 0.92 [95% CI: 0.85-0.99]; p < .001), fresh fruit (OR = 0.83 [95% CI: 0.76-0.90]; p < .001), dried fruit (OR = 0.43 [95% CI: 0.39-0.46]; p < .001), fresh fruit juice (OR = 0.66 [95% CI: 0.62-0.72]; p < .001), packed juice (OR = 0.91 [95% CI: 0.84-0.98]; p < .009), milk (OR = 0.51 [95% CI: 0.47-0.55]; p < .001), yogurt (OR = 0.86 [95% CI: 0.79-0.93]; p ≤ .001), and coffee (OR = 0.82 [95% CI: 0.76-0.89]; p ≤ .001).

CONCLUSIONS

The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications.

Bedtimes and Blood Pressure: A Prospective Cohort Study of Mexican Adolescents

INTRODUCTION

Hypertension affects up to 5% of children worldwide and predicts later cardiovascular morbidity. Associations of short sleep and hypertension have been frequently reported in adults but less consistently in children. This study aims to examine the role of late bedtimes, a marker of short sleep duration, and potentially misaligned circadian rhythms, on incident elevated blood pressure (BP) in a large cohort of Mexican children.

METHODS

Participants included 2,033 adolescents recruited from public schools in Morelos, Mexico, free from elevated BP (<90th sex, age, and height-standardized percentile). Fourteen months later, all adolescents had a second BP assessment. We abstracted baseline habitual bedtimes from questionnaires to evaluate the association between bedtime and elevated BP incidence (≥90th percentile). Risk ratios and 95% confidence intervals were estimated with discrete-time mixed survival models, adjusting for potential confounders and accounting for clustering by school.

RESULTS

Participants were 12.5 (SD = 0.6) years old at baseline. At the follow-up visit 10% of adolescents had developed elevated BP. Compared to participants with a habitual weekday bedtime between 9 and 10 pm, those with a weekday bedtime 11 pm or later had a 1.87 times higher risk of developing elevated BP over the follow-up period (95% CI = 1.09, 2.21), after accounting for confounders. Participants with earlier weekday bedtimes also had a higher risk of elevated BP (RR = 1.96; 95% CI = 1.27, 3.01). The associations persisted after accounting for wake time.

CONCLUSION

These data showed a U-shaped association between weekday bedtime and elevated/high BP risk among Mexican adolescents.

Association of Sleep Duration and Blood Pressure in Adolescents: A Multicenter Study

BACKGROUND

Evidence suggests that sleep duration is related to blood pressure (BP), but the findings are still inconsistent for adolescents.

OBJECTIVE

To analyze the association between sleep duration and BP in Brazilian adolescents between 12 and 17 years of age.

METHODS

This study is part of the Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, cross-sectional study in 273 municipalities in Brazil. The sample consisted of 65,643 adolescents. Sleep duration was measured by a subjective method, and BP was measured by the oscillometric method. Multiple linear regression analyses were performed to evaluate the association between sleep duration and BP.

RESULTS

The mean sleep duration was 8.14 hours (± 1.40), with significant difference between the groups according to BP levels (P < 0.0001). The mean systolic and diastolic BP were 110.59 (± 11.87) and 65.85 (± 7.94) mm Hg, respectively, in the group of adolescents. Sleep duration was significantly associated with BP. Each increase 1 hour in sleep was associated with BP reduction in both sexes combined (P < 0.0001). Considering the effects of covariates, each increase 1 hour in sleep was associated with systolic BP (SBP) reduction among boys (P = 0.004) and SBP elevation among girls (P = 0.009), after full adjustment.

CONCLUSION

The results suggest that each increase in sleep duration was associated with SBP elevation among girls. Such findings may have important implications for cardiovascular health in adolescence.

Sleep quality, sleep duration, and their association with hypertension prevalence among low-income oldest-old in a rural area of China: A population-based study

OBJECTIVE

The relationship among sleep quality, sleep duration and hypertension prevalence is controversial in different age groups and genders. This study aimed to investigate sleep quality, sleep duration and their association with hypertension prevalence among low-income oldest-old in a rural area of China.

METHODS

A cross-sectional survey was conducted in a representative sample of 1066 adults aged 80-99 years in 2017. Logistic regression analysis was performed.

RESULTS

Among males, sleep durations of <6 h and 6-<7 h were significantly associated with hypertension prevalence, with odds ratios (ORs) of 3.15 (95% confidence interval (CI) 1.37 to 7.23) and 2.38 (95% CI 1.22 to 4.63), respectively. Among females, only the sleep duration of <6 h was associated with increased OR of hypertension of 3.49 (95% CI 1.50 to 8.09). Poor sleep quality was associated with hypertension for both genders (OR_men 1.67, 95% CI 1.12 to 2.49; OR_women 1.91, 95% CI 1.29 to 2.82). For women, a combination of poor sleep quality and any group of sleep duration, except for 7-<8 h, was associated with higher hypertension prevalence. For men, only the combination of poor sleep quality and short sleep duration (<7 h) was associated with high hypertension prevalence.

CONCLUSION

Short sleep duration and poor sleep quality are associated with hypertension prevalence of oldest-old. The prevention of hypertension in older adults should be investigated from the perspective of sleep improvement.

Associations of Infant Sleep Duration with Body Composition and Cardiovascular Health to Mid-Adolescence: The PEAS Kids Growth Study

Background: Short sleep duration in childhood has often been linked with obesity in later childhood or adolescence. However, whether infant sleep duration affects body composition trajectories and cardiovascular health through to mid-adolescence remains unknown. Methods: Participants were 336 adolescents from a community-based prospective birth cohort in Melbourne, Australia. Mothers completed 24-hour time diaries, including infant sleep in 5-minute intervals at ages 2, 4, and 12 months. BMI and body composition outcomes were measured 6-monthly between 4 and 6.5 years and at 10 and 14 years. Cardiovascular outcomes at 14 years comprised blood pressure, pulse wave velocity, retinal arteriole-to-venule ratio, and carotid intima-media thickness. We used multivariable linear regression and multinomial logistic regression analyses adjusted for sex, age, BMI at birth, gestational age, ethnicity, maternal education, maternal BMI, and neighborhood socioeconomic position. Results: At 2 months, infants slept on average 14.1 hours [standard deviation (SD) 1.9], decreasing to 13.4 hours (SD 2.0) by 12 months. We observed no associations between the different sleep duration time points in infancy and later BMI or body composition. Moreover, a shorter sleep duration did not increase the odds of being on a high body composition trajectory compared with longer sleep (e.g., odds ratio per hour of sleep at 4 months is 0.85, 95% confidence interval 0.65-1.11). Infant sleep duration was also not associated with cardiovascular function or large or small artery structure at 14 years of age. Conclusions: We found no evidence that sleep duration very early in life affects adolescent body composition or cardiovascular health.

Association of Sleep Duration with Obesity and Cardiometabolic Risk Factors in Children and Adolescents: A Population-Based Study

This study aimed to evaluate the relationships between sleep duration and overweight/obesity, obesity, and metabolic syndrome (MetS) and its components in children and adolescents. A total of 6,048 participants aged 10–18 years were divided into the following four sleep-duration groups based on age-specific sleep duration: i) very short; ii) short; iii) recommended; and iv) long. The participants in the very short sleep-duration group had an increased odds ratio (OR) of 1.76 for overweight/obesity, 1.69 for obesity, and 1.49 for elevated waist circumference (WC) compared with the recommended sleep-duration group. The subjects in the long sleep-duration group had an increased OR of 2.71 for elevated triglyceride (TG) compared with those in the recommended sleep-duration group. In subgroup analyses, boys in the very short sleep-duration group exhibited an increased OR of 1.78 for overweight/obesity compared with those in the recommended sleep-duration group. Compared with girls in the recommended sleep-duration group, those in the very short sleep-duration group exhibited an increased OR of 1.69 for overweight/obesity, 2.28 for obesity, and 1.57 for elevated WC; in contrast, girls in the very short sleep-duration group exhibited a decreased OR of 0.58 for elevated TG. The girls in the long sleep-duration group had an increased OR of 3.86 for elevated TG compared with those with recommended sleep-duration. Our results suggest that shorter sleep durations may be related to overweight/obesity, obesity, and central obesity, and longer sleep durations may be associated with elevated TG. However, the nature of these relationships may be dependent on sex.

Could emotional eating act as a mediator between sleep quality and food intake in female students?

Background

Poor sleep quality is associated with overeating and unhealthy eating. The aim of this study was to investigate if emotional eating could act as a mediator between poor sleep quality and energy/macronutrients intake.

Methods

This cross-sectional study was performed with 150 female school-age students, 13 to 19 years old, living in Tabriz, Iran. The Pittsburgh Sleep Quality Index (PSQI) and Emotional Eating Questionnaire (EEQ) were completed for data collection. Intake of energy and proportion of calorie from carbohydrate, protein, and fat were evaluated by a semi-quantified food frequency questionnaire. The data were analyzed using structural equation modeling.

Results

The mean (SD) of age, weight, and BMI were not statistically different between poor and good sleepers. The mean (SD) of PSQI score was 6.73 ± 2.88, with 75.3% of the participants experiencing poor sleep quality (PSQI> 5). Students with poor sleep quality had increased energy intake and their proportion of calorie intake from fat was higher (p<0.05). There was a positive correlation between poor sleep quality and emotional eating; however, emotional eating did not mediate the relationship between poor sleep quality and energy/macronutrients intake.

Conclusions

Emotional eating did not act as a mediator between poor sleep quality and energy/macronutrients intake in female students. However, poor sleep quality directly influenced energy intake and the proportion of calorie intake from fat as well as emotional eating.

Sleep duration and blood pressure in children: Analysis of the pan-European IDEFICS cohort

The present study aims to examine the cross-sectional and longitudinal association between self-reported nocturnal sleep duration, blood pressure, and hypertension in European children, aged 2-9.9 years, participating in the IDEFICS project. Blood pressure (BP) and the main anthropometric indices were measured according to standardized procedures. Childhood elevated BP and hypertension were defined according to the European Society of Hypertension Guidelines for children and adolescents. Parents reported lifestyle and socio-demographic data. Nocturnal sleep duration was assessed as part of a parental 24-h recall and categorized as follows: (a) ≤9 hours/night; (b) >9 hours to ≤10 hours/night; (c) >10 hours to ≤11 hours/night; and (d) >11 hours/night. A complete set of variables included in the present analysis was provided by 7974 participants (boys/girls = 4049/3925) at the baseline survey (T0). Of them, 5656 were re-examined 2 years later at follow-up (T1). Children reporting shorter sleep duration at T0 had significantly higher BP values (P for trend < 0.001) compared to those who slept more. Prospective analyses showed that shorter sleep duration at baseline predicted, over the 2-year follow-up, higher increases in systolic blood pressure and diastolic blood pressure, after adjustment for age, sex, country of origin, BMI z-score, parental education, physical activity, screen time, and T0 value of the examined outcome variables (P for trend < 0.001). Our findings reveal that shorter sleep duration is associated with higher BP in childhood, suggesting that sleep may be a potential risk factor for hypertension later in life.

Association between sleep duration and high blood pressure in adolescents: a systematic review and meta-analysis

CONTEXT

Sleep has been assessed as a risk factor for health consequences. Among adults, excessively longer and shorter sleep durations are associated with high blood pressure (BP), but knowledge of the association between sleep duration and high BP among adolescents is limited.

OBJECTIVES

To estimate the associations between sleep duration and high BP in adolescents.

METHODS

PubMed, Web of Science, and Cochrane databases were searched for eligible publications up until 20 November 2017. This study reviewed the reference lists from retrieved articles to search for relevant studies. Pooled odds ratios (ORs) were calculated using a random-effects meta-analysis. Sub-group and sensitivity analyses were conducted to identify heterogeneity. Publication bias was evaluated using Egger's test.

RESULTS

Seven studies involving 21,150 participants were included, with ages ranging from 10-18 years. For primary analysis, compared with the reference sleep duration, the pooled OR for high BP was 1.51 (95% confidence interval [CI] = 1.04-2.19) for the short sleep duration overall. For long sleep duration, the pooled OR was 1.04 (95% CI = 0.78-1.38). Further sub-group analysis showed that short sleep duration had a higher risk of incident high BP in males (OR = 1.55, 95% CI = 1.24-1.93) than in females (OR = 1.23, 95% CI = 0.47-3.22).

CONCLUSIONS

Among adolescents, and particularly male adolescents, short sleep duration may be a risk factor for high BP. More attention should be given to this lifestyle factor.

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.

Association of sleep duration with metabolic syndrome and its components in children and adolescents; a propensity score-matched analysis: the CASPIAN-V study

OBJECTIVE

This study aims to evaluate the association of sleep duration with metabolic syndrome (MetS) and its components in a pediatric population.

METHODS

This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examinations and laboratory tests were performed using standard protocols. The analysis was conducted based on the propensity score matching and conditional logistic regression was used to evaluate the association of short sleep (less than 8 h a day) and the onset of sleep with MetS and its components. Results of conditional logistic regression was reported as odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Overall, 3843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.3 (3.2) years and 50.6% were boys. In the multivariate model, individuals who slept less than 8 h a day had significantly higher odds of MetS (OR 2.05, 95% CI 1.19-3.63) and high blood pressure (BP) (OR 1.46, 95% CI 1.04-2.06). Association between short sleep duration with other MetS components (including abdominal obesity, hypertriglyceridemia, hyperglycemia, and low levels of high-density lipoprotein-cholesterol was not statistically significant (P > 0.05). Moreover, association between the onset of sleep with MetS and its components was not statistically significant (P > 0.05).

CONCLUSION

Short sleep duration is associated with increased risk of MetS and high BP in children and adolescents. The clinical impact of current findings should be assessed in future longitudinal studies.

Insufficient Sleep Duration Is Associated With Dietary Habits, Screen Time, and Obesity in Children

STUDY OBJECTIVES

To examine sleep duration and the association between insufficient sleep duration and life- style factors in a representative sample of Greek children and adolescents.

METHODS

Population data derived from a school-based health survey carried out in spring 2015 on 177,091 children (51% male) aged 8 to 17 years (participation rate was approximately 40% of the total population). Dietary habits, sleeping hours (weekdays and weekend), physical activity status, and sedentary activities were assessed through electronic questionnaires completed at school with assistance of teachers. Anthropometric and physical fitness measurements were obtained by physical education teachers.

RESULTS

A greater proportion of males than females (42.3% versus 37.3%, P < .001) and of children compared with adolescents (42.1% versus 32.8%, P < .001) reported insufficient sleep duration. Insufficient sleep duration was associated with unhealthy dietary habits such as skipping breakfast (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.25-1.35), fast-food consumption (OR 1.35, 95% CI 1.29-1.41), and consuming sweets regularly (OR 1.32, 95% CI 1.25-1.39). Insufficient sleep duration was found to be associated with insufficient dietary habits (OR 0.59, 95% CI 0.54-0.64), increased screen time (OR 1.26, 95% CI 1.21-1.31), and being overweight/obese (OR 1.21, 95% CI 1.17-1.25), after adjusting for several covariates.

CONCLUSIONS

Insufficient sleep duration was associated with an unhealthy lifestyle profile among children and adolescents in this study. Results support the development of interventions to help students improve sleep duration.

Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents

: media-1vid110.1542/5778442247001PEDS-VA_2017-4085Video Abstract BACKGROUND AND OBJECTIVES: Shorter sleep duration is associated with childhood obesity. Few studies measure sleep quantity and quality objectively or examine cardiometabolic biomarkers other than obesity.

METHODS

This cross-sectional study of 829 adolescents derived sleep duration, efficiency and moderate-to-vigorous physical activity from >5 days of wrist actigraphy recording for >10 hours/day. The main outcome was a metabolic risk score (mean of 5 sex-specific z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance), for which higher scores indicate greater metabolic risk. Secondary outcomes included score components and dual-energy radiograph absorptiometry fat mass. We measured socioeconomic status, race and/or ethnicity, pubertal status, and obesity-related behaviors (television-viewing and fast food and sugar-sweetened beverage consumption) using questionnaires.

RESULTS

The sample was 51.5% girls; mean (SD) age 13.2 (0.9) years, median (interquartile range) sleep duration was 441.1 (54.8) minutes per day and sleep efficiency was 84.0% (6.3). Longer sleep duration was associated with lower metabolic risk scores (-0.11 points; 95% CI: -0.19 to -0.02, per interquartile range). Associations with sleep efficiency were similar and persisted after adjustment for BMI z score and physical activity, television-viewing, and diet quality. Longer sleep duration and greater sleep efficiency were also favorably associated with waist circumference, systolic blood pressure, high-density lipoprotein cholesterol, and fat mass.

CONCLUSIONS

Longer sleep duration and higher sleep efficiency were associated with a more favorable cardiometabolic profile in early adolescence, independent of other obesity-related behaviors. These results support the need to assess the role of sleep quantity and quality interventions as strategies for improving cardiovascular risk profiles of adolescents.

Association of sleep disturbances with obesity, insulin resistance and the metabolic syndrome

Insufficient sleep, which has become endemic in recent years, has been variably associated with increased risk of obesity, disorders of glucose and insulin homeostasis, and the metabolic syndrome; to a lesser degree, so has excessive sleep. This review summarizes recent epidemiological and pathophysiological evidence linking sleep disturbances (primarily abnormalities of sleep duration) with obesity, insulin resistance, type 2 diabetes and the metabolic syndrome in children and 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.

Differences in self-reported weekend catch up sleep between children and adolescents with and without primary hypertension

Background

The data on the association of sleep duration and blood pressure in the pediatric age group have been mixed and most studies have focused on weekday sleep duration. The purpose of this study was to compare the weekday and weekend sleep patterns between children and adolescents with newly diagnosed primary hypertension and a normotensive control group.

Methods

Children and adolescents from a pediatric nephrology clinic, aged 6-18 years with newly diagnosed primary hypertension were compared to an age and sex matched normotensive control group from a general pediatric clinic. The questions about bed time and getting out of bed times from the Pediatric Sleep Questionnaire (PSQ) were used to obtain weekday and weekend bed time, getting out of bed time and sleep duration. The Pediatric Daytime Sleepiness Scale (PDSS) was used to assess subjective sleepiness.

Results

In both groups of 60 subjects each, weekday total sleep time was similar. Subjects in both groups went to bed later and woke up later on the weekends. However, in the hypertensive group, weekend getting out of the bed time was earlier (8:52 AM ±93 min vs. 9:36 AM ±88 min, p = 0.013) and weekend catchup sleep was about 40 min less (62.8 ± 85.5 vs. 102.7 ± 84.9, p = 0.035). Hypertensive children perceived less subjective sleepiness (PDSS scores 8.28 ± 4.88 vs. 10.63 ± 5.41, p = 0.007). The p values were calculated after adjusting for body mass index (BMI), race, daytime nap, caffeine use, sleep related breathing disorder (SRBD) scale and periodic limb movement of sleep (PLMS) scale subcomponents of the PSQ.

Conclusions

Hypertensive children obtained less weekend catch up sleep and reported less subjective sleepiness compared to the control group. More weekend sleep may potentially mitigate the effect of weekday sleep deprivation on blood pressure.

The Relationship Between Blood Pressure and Sleep Duration in Turkish Children: A Cross-Sectional Study

OBJECTIVE

As in adults, hypertension is also an important risk factor for cardiovascular disease in children. We aimed to evaluate the effect of sleep duration on blood pressure in normal weight Turkish children aged between 11-17 years.

METHODS

This cross-sectional study was conducted in the primary and secondary schools of the two central and ten outlying districts of Kayseri, Turkey. Subjects were 2860 children and adolescents (1385 boys, 1475 girls). Systolic and diastolic blood pressures were measured according to the recommendations of the Fourth Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Sleep duration was classified as follows: ≤8 hours, 8.1-8.9 hours, 9.0-9.9 hours or ≥10 hours.

RESULTS

For short sleeper boys and girls (participants with a sleep duration ≤8 h) the prevalence of prehypertension and hypertension was 35.0% and 30.8%, respectively. In univariate binary logistic regression analyses (age-adjusted), each unit increment in sleep duration (hours) in boys and girls, decreased the prehypertension and hypertension risk by 0.89 [odds ratio (OR)] [confidance interval (CI); 0.82-0.98] and 0.88 (OR) (CI; 0.81-0.97), respectively (p<0.05). In multiple binary logistic regression analyses [age- and body mass index (BMI)-adjusted] the location of the school and sleep duration categories were shown to be the most important factors for prehypertension and hypertension in both genders, while household income was the most important factor, only in boys.

CONCLUSIONS

A sleep duration ≤8 h is an independent risk factor for prehypertension and hypertension in Turkish children aged 11-17 years.

Impact of Sleep Duration and Weekend Oversleep on Body Weight and Blood Pressure in Adolescents

Introduction

Weekend oversleep or catchup sleep is a frequent occurrence in children, but there are relatively little data concerning its impact on weight and blood pressure. The aim of this study was to assess the association between sleep duration and oversleep, and weight and blood pressure in adolescents.

Methods

Sleep duration, weight and blood pressure of 327 children (51.4% boys, mean age 13.3 ± 1.7 years) who had polysomnograms performed during both exam cycles of the Tucson Children's Assessment of Sleep Apnea study (TuCASA) were analyzed. Sleep duration on school nights and non-school nights was used to compute a weighted average of child and parent reported overall sleep duration respectively. Oversleep was defined as the difference between self and parent reported weekend sleep and weekday sleep separately. Simple correlations between overall sleep duration, sleep on school and non-school nights and oversleep, and blood pressure, standardized body mass index (BMI), snoring, respiratory disturbance index (RDI) and age were calculated. Significant bivariate associations then were used to develop multivariate partial correlation models.

Results

Unadjusted negative correlations with BMI were noted for parent reported total sleep duration at the 1^st exam cycle, parent and child reported total sleep and school night sleep duration, and parent reported non-school night sleep duration at the 2^nd exam cycle. Additionally, for BMI, positive correlations were observed for log RDI at both exam cycles and snoring at the 2^nd exam cycle. For blood pressure, there were positive associations with age, parent reported oversleep, caffeine consumption and snoring. Additionally, for blood pressure, negative relationships were observed with parent reported total sleep duration at the 1^st exam cycle, and parent and child reported total sleep and school night sleep durations at the 2^nd exam cycle. Partial correlations found that BMI was negatively correlated with parent reported total sleep duration at the 1^st exam cycle and parent reported total sleep duration at the 2^nd exam cycle, and positively correlated with snoring and log RDI at both exam cycles. Systolic blood pressure was only associated with age and snoring. Diastolic blood pressure was positively correlated with age and caffeine consumption, and negatively correlated with parent reported total and school night sleep duration. Oversleep and child reported sleep duration were not represented in any of these models.

Conclusion

Lower amounts of sleep especially on school nights is associated with higher body weight and blood pressure. Oversleep was not associated with either body weight or blood pressure.

Prevalence of hypertension and prehypertension in adolescence in Ahvaz, Iran

BACKGROUND

High blood pressure is a risk factor for some disease like stroke, coronary heart disease, and renal failure. High blood pressure in children is an increasing health problem.

OBJECTIVES

The aim of this study was to determine prevalence of hypertension and pre-hypertension age between 10 to 17 years old.

PATIENTS AND METHODS

This descriptive analytic study was conducted using multiphase sampling method in Ahvaz (Southwest of Iran). A questionnaire include: height, weight, and body mass index, systolic and diastolic blood pressures filled for each participant. Blood pressure was measured twice for each person. For the diagnosis of hypertension, the fourth report of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents of the National Health Institute of United States was used.

RESULTS

Total participants of the study were 1707children and adolescents including 922 boys (54%) and 785 girls (46%). The prevalence of high blood pressure was 1.7% (2.5% in boys and 0.8%). The prevalence of pre-hypertension was 9%(7.6% in boys, 10.6% in girls). The mean systolic and diastolic blood pressures increased with increasing body mass index.

CONCLUSIONS

The prevalence of high blood pressure was found to be lower than other studies in our country. The prevalence of the high blood pressure in boys was significantly higher than girls. This study, like other studies showed high correlation between being overweight and an increase in systolic and diastolic blood pressure.

Prehypertension and psychosocial risk factors among university students in ASEAN countries

Background

Existing evidence suggests that the cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. The aim of this study was to evaluate the prevalence of prehypertension, hypertension and to identify psychosocial risk factors for prehypertension among university students in Association of South East Asian Nation (ASEAN) countries.

Methods

Based on a cross-sectional survey, the total sample included 4649 undergraduate university students (females = 65.3%; mean age 20.5, SD = 2.9, age range of 18–30 years) from 7 ASEAN countries (Indonesia, Laos, Malaysia, Myanmar, Philippines, Thailand and Vietnam). Blood pressure, anthropometric, health behaviour and psychosocial variables were measured.

Results

Overall, 19.0% of the undergraduate university students across ASEAN countries had prehypertension, 6.7% hypertension and 74.2% were normotensives. There was country variation in prehypertension prevalence, ranging from 11.3% in Indonesia and 11.5% in Malaysia to above 18% in Laos, Myanmar and Thailand. In multivariate analysis, sociodemographic variables (male gender, living in an upper middle income country, and living on campus or off campus on their own), nutrition and weight variables (not being underweight and obese, having once or more times soft drinks in a day and never or rarely having chocolate or candy), heavy drinking and having depressive symptoms were associated with prehypertension.

Conclusion

The study found a high prevalence of prehypertension in ASEAN university students. Several psychosocial risk factors including male gender, obesity, soft drinks consumption, heavy drinking and depression symptoms have been identified which can help in intervention programmes.

Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children

BACKGROUND

The aim of this study is to determine if sleep duration in early childhood is associated with cardiometabolic risk (CMR) in later childhood as assessed by a CMR cluster score [sum of age- and sex-standardized z-scores of waist circumference (WC), systolic blood pressure, triglycerides, glucose, and (inverse) high-density lipoprotein (HDL)]. Secondary objectives included examining sleep duration and the individual CMR factors and BMI z-score.

PATIENTS AND METHODS

A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n = 597) with parent-reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood CMR, adjusting for relevant covariates.

RESULTS

Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted β = -0.028 (95% confidence interval: -0.049 to -0.007), p = 0.009].

CONCLUSIONS

Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.

Inverse Relationship between Sleep Duration and Cardio-Ankle Vascular Index in Children

AIM

Poor sleep has been shown to be associated with the development of cardiovascular risk factors, such as obesity, in both adults and children. This study aimed to investigate the relationship between sleep duration and arterial stiffness indices in Japanese children and early adolescents.

METHODS

The data on 102 students (56 males, 46 females; mean age, 11.9±1.8 years) were analyzed. As non-invasive arterial stiffness parameters, the cardio-ankle vascular index (CAVI) and heart-ankle pulse wave velocity (haPWV) were evaluated. Their students' sleep habits (bedtime and wake times on a usual weekday) were investigated using questionnaires, and based on these, their sleep durations were calculated.

RESULTS

The CAVI values in the males and females were 4.8±0.9 and 4.7±0.9 (arbitrary unit), respectively. haPWV values in the males and females were 5.5±0.6 and 5.4±0.6 m/s, respectively. Sleep duration in the males, but not in the females, was negatively correlated with CAVI (r=－0.356) and haPWV (r=－0.356), suggesting that students with short sleep duration could have increased arterial stiffness. After adjusting for confounders, such as age, sex, systolic blood pressure, heart rate, adiposity, and physical fitness, the correlation of sleep duration with CAVI, but not with haPWV, was still significant (partial r=－0.253, p＜0.05).

CONCLUSION

Our findings suggest that shorter sleep duration influences arterial stiffening even in childhood.

Association between sleep duration and cardiac structure in youths at risk for metabolic syndrome

The evidence for a link between sleep duration and cardiovascular risk is accumulating in youths, but no study has yet investigated the relationship between sleep duration and change of cardiac structure. In this study, we recruited 559 youths aged 14–28 years from the cohort of Beijing Child and Adolescent Metabolic Syndrome Study. Questionnaire, color Doppler echocardiography, oral glucose tolerance test and blood biomarkers analyses were performed. We found that sleep duration was negatively correlated with body mass index, waist circumstance, and HbA1c (all P < 0.05), but not with adiponectin and leptin. Meanwhile, participants with shorter sleep duration (≤7 h) had larger interventricular septal diastolic thickness, left ventricular (LV) end-diastolic diameter, LV posterior wall thickness, LV mass (LVM), and LV mass index (LVMI), compared to participants in 7–9 h/night or >9 h/night group. Findings remained significant after adjustment for the major confounding factors (P < 0.05). Multivariate regression modeling revealed that each additional hour of sleep was associated with smaller LVM (β: −3.483, P < 0.0001) and LVMI (β: −0.815, P < 0.0001). Our findings suggest that short sleep has a possible direct effect on cardiac remodeling, occurring already at young ages.

Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion

ABSTRACT

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts.

COMMENTARY

A commentary on this article apears in this issue on page 1439.

Sleep duration and blood pressure: a longitudinal analysis from early to late adolescence

The aim of this study was to evaluate the association between sleep duration and blood pressure using a cross-sectional and longitudinal approach. As part of a population-based cohort, 1403 adolescents were evaluated at 13 and 17 years old. Sleep duration was estimated by the difference between self-reported usual bedtime and wake-up time. Blood pressure was measured using the auscultatory method. Regression coefficients (β) and respective 95% confidence intervals were computed to evaluate the association between sleep duration and blood pressure, using linear regression models adjusted for practice of sports and body mass index at 17 years old. The mean (standard deviation) sleep duration at 13 years old was 9.0 (0.76) h per day, and on average it decreased by 46 min up to 17 years old. The median (25th-75th) systolic blood pressure at 17 years old was 110.0 (103.5-119.0) mmHg in females and 114.0 (106.0-122.0)mmHg in males (P < 0.001); for diastolic blood pressure the values were 66.0 (60.0-71.0) and 69.0 (62.0-75.0) mmHg, respectively (P < 0.001). In cross-sectional analysis, at 17 years old, after adjustment, a positive association was found between sleep duration and blood pressure, significant only for systolic blood pressure among females [β = 0.730 (0.005; 1.455)]. In girls, no significant association was found between sleep duration at 13 years old and blood pressure at 17 years old, but in males an inverse association was found between sleep duration at 13 years old and blood pressure at 17 years old significant only for systolic blood pressure [β = -1.938 (-3.229; -0.647)]. This study found no association between sleep duration at 13 years old and blood pressure at 17 years old in girls, but among males an inverse association was found.

Age- and gender-specific associations between sleep duration and incident hypertension in a Chinese population: the Kailuan study

The objective of this study was to explore the age- and sex-dependent association between sleep duration and incident hypertension in a Chinese population. The Kailuan prospective cohort study recruited 101 510 participants. Those participants were followed for an average of 3.98 years and the data obtained from 32 137 participants out of 101 510 were analyzed in this study. Sleep duration was categorized as five groups of⩽5, 6, 7, 8 and ⩾9 h. Cox proportional-hazards models were used to analyze the association of sleep duration with incident hypertension. The 3.98 years' follow-up data showed that 12 732 out of 32 137 participants developed hypertension. Short duration of sleep (⩽5 h per night) was associated with an increased risk of hypertension in woman (hazard ratio (HR) 1.27; 95% confidence interval (CI) 1.02 to 1.58) and participants aged <60 years (HR 1.11; 95% CI 1.02-1.21), when compared with the group reported with 7 h of sleep per day. This study suggested that short sleep duration could cause an increased risk of hypertension in Chinese females and population aged <60 years.

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.

Sleep characteristics and cardiovascular risk in children and adolescents: an enumerative review

Cardiovascular risk factors develop in childhood and adolescence. This enumerative review addresses whether sleep characteristics, including sleep duration, continuity, quality, and daytime sleepiness, are associated with cardiovascular risk factors in young people. Thirty-nine studies were identified, which examined the following risk factors: metabolic syndrome, glucose and insulin, lipids, blood pressure, and cardiovascular responses to psychological stressors. Due to the availability of other reviews, 16 longitudinal studies of obesity published in 2011 and later were also included in this report. Excluded from the review were studies of participants with suspected or diagnosed sleep disorders and reports from sleep deprivation experiments. Combining studies, evidence was strongest for obesity, followed by glucose, insulin, blood pressure (especially ambulatory blood pressure), and parasympathetic responses to psychological stressors. There was little evidence for metabolic syndrome cluster, lipids, and blood pressure responses to psychological stressors. The more positive associations were obtained for studies that incorporated objective measures of sleep and that included adolescents. The foundational evidence is almost entirely cross-sectional, except for work on obesity. In summary, available evidence suggests that the associations between sleep characteristics and cardiovascular risk vary by risk factor. It is time to conduct studies to determine antecedent and consequent relationships, and to expand risk factors to include markers of inflammation.

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.

Sleep duration, schedule and quality among urban Chinese children and adolescents: associations with routine after-school activities

Background

With rapid urbanization accompanied by lifestyle changes, children and adolescents living in metropolitan areas are faced with many time use choices that compete with sleep. This study reports on the sleep hygiene of urban Chinese school students, and investigates the relationship between habitual after-school activities and sleep duration, schedule and quality on a regular school day.

Methods

Cross-sectional, school-based survey of school children (Grades 4–8) living in Shanghai, China, conducted in 2011. Self-reported data were collected on students’ sleep duration and timing, sleep quality, habitual after-school activities (i.e. homework, leisure-time physical activity, recreational screen time and school commuting time), and potential correlates.

Results

Mean sleep duration of this sample (mean age: 11.5-years; 48.6% girls) was 9 hours. Nearly 30% of students reported daytime tiredness. On school nights, girls slept less (p<0.001) and went to bed later (p<0.001), a sex difference that was more pronounced in older students. Age by sex interactions were observed for both sleep duration (p=0.005) and bedtime (p=0.002). Prolonged time spent on homework and mobile phone playing was related to shorter sleep duration and later bedtime. Adjusting for all other factors, with each additional hour of mobile phone playing, the odds of daytime tiredness and having difficulty maintaining sleep increased by 30% and 27% among secondary students, respectively.

Conclusion

There are sex differences in sleep duration, schedule and quality. Habitual activities had small but significant associations with sleep hygiene outcomes especially among secondary school students. Intervention strategies such as limiting children’s use of electronic screen devices after school are implicated.

Longitudinal associations of sleep curtailment with metabolic risk in mid-childhood

OBJECTIVE

To examine associations of chronic insufficient sleep with mid-childhood cardiometabolic health.

METHODS

At 6 months and yearly from 1 to 7 years, mothers participating in the Project Viva cohort reported children's 24-h sleep duration. The main exposure was a sleep curtailment score, ranging from 0 (maximal curtailment) to 13 (never having curtailed sleep). The main outcome was a mid-childhood metabolic risk score, derived as the mean of five sex- and cohort-specific z scores for waist circumference, systolic blood pressure, HDL cholesterol (scaled inversely), and log-transformed triglycerides and HOMA-IR; higher scores indicate higher risk.

RESULTS

The mean (SD) sleep score was 10.0 (2.8); 5.1% scored 0-4, 13.9% scored 5-7, 14.1% scored 8-9, 28.7% scored 10-11, and 38.3% scored 12-13. Mean (SD, range) metabolic risk score was -0.03 (0.6, -1.8 to 2.6). In multivariable models, the metabolic risk score difference for children with most versus least curtailed sleep was 0.29 units (95% confidence interval [CI]: 0.02, 0.57). Further adjustment for mid-childhood BMI z score attenuated this difference to 0.08 units (95% CI: -0.14, 0.30).

CONCLUSIONS

Chronic insufficient sleep from infancy to school-age was associated with higher mid-childhood metabolic risk. This association was explained by sleep duration's influence on mid-childhood adiposity.

A review of evidence for the link between sleep duration and hypertension

There are lines of evidence from experimental sleep deprivation studies, population-based epidemiological studies, and an interventional study that point to the potential efficacy of adequate quality sleep to prevent and treat hypertension. Experimental sleep restriction has been shown to raise blood pressure and heart rate. Insufficient sleep on a chronic basis can raise average 24-hour blood pressure and lead to structural adaptations that entrain the cardiovascular system to operate at an elevated blood pressure equilibrium and increase the risk for hypertension. Disruptions in the timing and duration of sleep could also disrupt circadian rhythmicity and autonomic balance, which can increase the prevalence of the nondipping pattern, disturb diurnal rhythm of cardiac output, and increase blood pressure variability. Short sleep duration has been found to be associated with higher blood pressure and hypertension in both cross-sectional and longitudinal epidemiological studies. The association appears stronger in middle-aged adults and in women. Experimental sleep extension has been shown to significantly reduce blood pressure in individuals with prehypertension or stage 1 hypertension. The observed association between sleep duration and hypertension raises the hypothesis that interventions to extend sleep and improve sleep quality could serve as effective primary, secondary, and tertiary preventive measures for hypertension.

Influence of different behavioural factors and obesity status on systolic blood pressure among pre-school children

AIM

The aim of this study was to examine the association between sleeping time (SLT), time spent using screen (ST) and weight status with Systolic Blood Pressure (SBP) among pre-school children.

SUBJECTS AND METHODS

The sample comprised 628 pre-school children (50% female), aged 3-6 years-old. SLT and ST were reported by parents. BMI values were categorized according to IOTF. SBP cut points were based on SBP percentiles for age, sex and height. ST was dichotomized according to the following criteria: ≤1 hour vs >1 hour and SLT: ≤10.5 hours vs >10.5 hours. Participants were then categorized into one of four category profiles: Low ST/High SLT; High ST/Low SLT; Low ST/Low SLT and High ST/High SLT.

RESULTS

Children assigned to the High ST/Low SLT group were 2-times more likely to have high SBP values compared to those who were assigned to the Low ST/High SLT group (OR = 2.4; 95% CI = 1.1-5.1). Furthermore, those who were assigned as overweight and obese were more likely to be classified as having elevated BP (OR = 1.8; 95% CI = 1.1-3.2 for overweight and OR = 3.1; 95% CI = 1.6-5.8 for obese, respectively).

CONCLUSION

The data showed that high ST exposure time and low SLT are associated with enhanced blood pressure in children at pre-school.

Associations of short sleep duration with prehypertension and hypertension among Lithuanian children and adolescents: a cross-sectional study

Background

Recent epidemiological studies have found that the prevalence of high blood pressure (BP) has significantly increased among children and adolescents. The aim of this study was to examine the associations between short sleep duration and prehypertension and hypertension in Lithuanian children and adolescents aged 12 to 15 years.

Methods

A cross-sectional study was conducted from November 2010 to April 2012. The participants with high BP (≥90th percentile) were screened on two separate occasions. Self-reported sleep duration was evaluated using questionnaires. Data on 6,940 subjects aged 12–15 years were analyzed. Adjusted odds ratios (aORs) with 95% confidence intervals for the associations were estimated using multivariate logistic regression models. Short sleep duration was defined as <8 hours per day (h/day).

Results

The prevalence of prehypertension and hypertension in the current sample was 12.6% and 22.5%, respectively. The percentages of the subjects with sleep durations of <7 (h/day), 7– < 8 h/day, and ≥8 h/day were 8.7%, 21.0%, and 70.3%, respectively. After adjusting for age, sex, body mass index, physical activity, and smoking, significant associations were found between short sleep duration and high BP, including prehypertension (7– < 8 h/day: aOR = 1.77; 95% CI, 1.48–2.12; <7 h/day: aOR = 2.18; 95% CI, 1.70–2.79) and hypertension (7– < 8 h/day: aOR = 1.99; 95% CI, 1.72–2.31; <7 h/day: aOR = 2.28; 95% CI, 1.85–2.80) (all P values <0.001), compared to participants who were sleeping longer (≥8 h/day).

Conclusions

Prehypertension and hypertension were associated with short sleep duration among Lithuanian children and adolescents aged 12 to 15 years.

Prehypertension and associated factors among university students in the Philippines

BACKGROUND

Prehypertension is a new category of blood pressure, and is considered a cardiovascular risk factor. The aim of this study was to estimate the prevalence of prehypertension and its associated factors in young adults in the Philippines.

METHODS

Undergraduate university students from all areas of study in the University of the Philippines-Visayas were invited to participate. Prehypertension was defined as systolic blood pressure between 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg. Blood pressure, anthropometric, health behavior, and psychosocial stress variables were measured.

RESULTS

A total of 754 university students were included in the analysis (mean age, 18.3 ± 1.4 years, 74.3% women). Prehypertension prevalence was 13.9% (36.1% in men, 6.8% in women), and hypertension prevalence was 2.4% (6.6% in men, 1.1% in women). The condition of prehypertension was associated with body mass index obesity (OR: 5.14, CI: 2.70 to 9.79), male gender (OR: 9.41, CI: 5.41 to 16.36), living off campus on their own (OR: 3.18, CI: 1.35 to 7.48), living with parents or guardians (OR: 2.83, CI: 1.20 to 6.60), and 19 years of age (OR: 2.81, CI: 1.55 to 5.11).

CONCLUSION

One out of every 7 young adults presented with prehypertension. This condition is associated with established risk factors.

Acute and chronic effects of sleep duration on blood pressure

OBJECTIVE

To evaluate the association between ambulatory blood pressure (ABP) and sleep duration as measured by 7-day sleep diary and nocturnal polysomnography in normal-weight adolescents without significant obstructive sleep apnea.

METHODS

Subjects aged 10 to 17.9 years with an obstructive apnea hypopnea index <5 underwent polysomnography for 9.5 hours and 24-hour ABP monitoring commencing at noon on the same day. ABP was divided into prepolysomnography, in bed during polysomnography, and postpolysomnography periods for separate analyses. Sleep duration (SpD7) was obtained from a 7-day sleep diary, reflecting the sleep pattern in the week before admission. Total sleep time (TST) and sleep efficiency (SpE) were obtained from polysomnography.

RESULTS

A total of 143 adolescents participated. SpD7 was inversely associated with systolic blood pressure (SBP) in prepolysomnography, in-bed, and postpolysomnography periods (all β = -2 mm Hg) and with diastolic blood pressure (DBP) in prepolysomnography and in-bed periods (all β = -1 mm Hg). TST was inversely associated with SBP in the postpolysomnography period (β = -1.5 mm Hg). SpE was inversely associated with SBP in in-bed period (β = -0.1 mm Hg) and with DBP in in-bed (β = -0.1 mm Hg) and postpolysomnography (β = -0.2 mm Hg) periods. Neither TST nor SpE was associated with SBP and DBP in prepolysomnography period.

CONCLUSIONS

Short sleep duration as reflected by 7-day sleep diary was associated with higher blood pressure in normal-weight adolescents. Occasional adequate sleep may partially ameliorate the risk of high blood pressure but may not completely reverse the effect of long-term sleep insufficiency.

Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors

BACKGROUND

Self-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues.

METHODS

Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5649). Self-reported sleep duration was categorized as very short (<5 h), short (5-6 h), normal (7-8 h), or long (≥9 h). Obesity, diabetes mellitus (DM), hypertension, and hyperlipidemia were objectively assessed by self-reported history. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses and cardiometabolic factor as outcome, with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity.

RESULTS

In adjusted analyses, very short sleep was associated with self-reported hypertension (odds ratio [OR], 2.02, [95% confidence interval {CI},1.45-2.81]; P<0.0001), self-reported hyperlipidemia (OR, 1.96 [95% CI, 1.43-2.69]; P<0.0001), objective hyperlipidemia (OR, 1.41 [95% CI, 1.04-1.91]; P=0.03), self-reported DM (OR, 1.76 [95% CI, 1.13-2.74]; P=0.01), and objective obesity (OR, 1.53 [95% CI, 1.03-1.43]; P=0.005). Regarding short sleep (5-6 h), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR, 1.22 [95% CI, 1.02-1.45]; P=0.03) self-reported obesity (OR, 1.21 [95% CI, 1.03-1.43]; P=0.02), and objective obesity (OR, 1.17 [95% CI, 1.00-1.38]; P<0.05). Regarding long sleep (≥9 h), no elevated risk was found for any outcomes. Interactions with race/ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among blacks and the relationship between short sleep and hypertension is strongest among non-Hispanic whites, blacks, and non-Mexican Hispanics/Latinos.

CONCLUSIONS

Short sleep duration is associated with self-reported and objectively determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.