Sleep status and blood pressure in a healthy normotensive female population

Association between sleep deficiency and cardiometabolic disease: implications for health disparities

BACKGROUND

Cardiometabolic diseases, which include obesity, diabetes, hypertension, and cardiovascular disease, are associated with reduced quality of life and reduced life expectancy. Unfortunately, there are racial/ethnic and socioeconomic disparities associated with these diseases such that minority populations, such as African Americans and Hispanics, and those of lower socioeconomic status, experience a greater burden. Several reports have indicated that there are differences in sleep duration and quality that mirror the disparities in cardiometabolic disease. The goal of this paper is to review the association between sleep and cardiometabolic disease risk because of the possibility that suboptimal sleep may partially mediate the cardiometabolic disease disparities.

METHODS

We review both experimental studies that have restricted sleep duration or impaired sleep quality and examined biomarkers of cardiometabolic disease risk, including glucose metabolism and insulin sensitivity, appetite regulation and food intake, and immune function. We also review observational studies that have examined the association between habitual sleep duration and quality, and the prevalence or risk of obesity, diabetes, hypertension, and cardiovascular disease.

CONCLUSION

Many experimental and observational studies do support an association between suboptimal sleep and increased cardiometabolic disease risk.

Sleep and the Social Matrix: Determinants of Health Status Beyond Objective Social Status

Aim

The purpose of this study was to examine the relationship between subjective social status (SSS) and objective socioeconomic status (SES) on sleep status (sleep duration and daytime sleepiness).

Method

The study sample included 73 primary care patients from a free medical clinic in which low-income individuals are primarily treated. Subjective social status was measured using the MacArthur Scale of Subjective Social Status which uses a pictorial format (social ladder) in order to assess current social status. Socioeconomic status was measured by assessing highest level of education and current income level.

Results

Community SSS did not significantly predict sleep duration or daytime sleepiness. Additional regression analyses were conducted and it was found that an overall model of U.S. SSS and community SSS significantly predicted perceived stress. Community SSS was found to be significantly associated with perceived stress. Regression results also indicated that an overall model of U.S. SSS and community SSS significantly predicted perceived health status.

Conclusion

It may be beneficial for clinicians working with low-income primary care populations to include measures of SSS in addition to the traditional measures of SES for multidimensional patient care.

Sleep to lower elevated blood pressure: study protocol for a randomized controlled trial

Background

Sleep is an essential component of good physical and mental health. Previous studies have reported that poor quality sleep is associated with an increased risk of hypertension and cardiovascular disease. Hypertension is the most common and important risk factor for cardiovascular disease, and even modest reductions in blood pressure can result in significant reductions in the risk of stroke and myocardial infarction. In this trial, we will determine the efficacy of an online sleep intervention in improving blood pressure, in participants with hypertension and poor sleep quality.

Methods

Trial design: Randomized-controlled, two-group, parallel, blinded, single-center, Phase II trial of 134 participants. Population and recruitment: Primary prevention population of participants with hypertension (systolic blood pressure, 130 to 160 mm Hg; diastolic blood pressure, <110 mm Hg) and poor sleep quality in a community setting. Intervention: Multicomponent online sleep intervention consisting of sleep information, sleep hygiene education, and cognitive behavioral therapy. Comparator: Standardized cardiovascular risk factor and lifestyle-education session (usual care). Primary outcome: Change in mean 24-hour ambulatory systolic blood pressure between baseline and 8-week follow-up. Hypertension has been selected as the primary outcome measure because of its robust association with both poor sleep quality and cardiovascular disease. Statistical analyses: Intention-to-treat analysis by using a linear mixed model.

Trial registration

ClinicalTrials.gov: NCT01809821, registered March 8, 2013.

Effects of sleep patterns and obesity on increases in blood pressure in a 5-year period: report from the Tucson Children's Assessment of Sleep Apnea Study

OBJECTIVES

To determine associations between body mass index and sleep on blood pressure in a 5-year period from childhood to adolescence.

STUDY DESIGN

Study consisted of a longitudinal, community-based sample of 334 children recruited at ages 6 through 11 years. Each participant underwent in-home polysomnography initially and then 5 years later. Individual systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated at both points during wake periods and classified as hypertensive when SBP or DBP was ≥ 95th standardized percentiles for height and weight.

RESULTS

Hypertension was present in 3.6% of the sample at time one and increased to 4.2% 5 years later. Obesity prevalence increased from 15.0% to 19.5%. Normal changes in sleep architecture were observed in the sample. With random effects modeling, which controlled for age, sex, and ethnicity, change in obesity status and decrease in total sleep time were indicated to be associated with increases in SBP. Change in obesity status was also associated with increases in DBP in the 5-year period. A trend for sleep-disordered breathing to increase SBP was noted.

CONCLUSIONS

Increases in SBP and DBP were associated with increasing body mass index and decreased total sleep time in a 5-year period from childhood to adolescence.

Does inadequate sleep play a role in vulnerability to obesity?

The prevalence of obesity is increasing rapidly worldwide, which is cause for concern because obesity increases the risk of cardiovascular disease and diabetes, reduces life expectancy, and impairs quality of life. A better understanding of the risk factors for obesity is therefore a critical global health concern, and human biologists can play an important role in identifying these risk factors in various populations. The objective of this review is to present the evidence that inadequate sleep may be a novel risk factor associated with increased vulnerability to obesity and associated cardiometabolic disease. Experimental studies have found that short-term sleep restriction is associated with impaired glucose metabolism, dysregulation of appetite, and increased blood pressure. Observational studies have observed cross-sectional associations between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes, and prevalent hypertension. Some studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. A few prospective studies have found a significant increased risk of weight gain, incident diabetes, and incident hypertension associated with inadequate sleep. Given the potential link between inadequate sleep and obesity, a critical next step is to identify the social, cultural, and environmental determinants of sleep, which would help to identify vulnerable populations. Future human biology research should consider variation in sleep characteristics among different populations and determine whether the associations between sleep and obesity observed in Western populations persist elsewhere.

Association between sleep duration and hypertension among Chinese children and adolescents

BACKGROUND

Short sleep duration was reported to be associated with an increased risk of hypertension among adults. The present study aimed to investigate this association in children and adolescents.

HYPOTHESIS

Short sleep duration is related to higher risk of hypertension among children and adolescents.

METHODS

We conducted a cross-sectional study of 4902 children and adolescents age 5 to 18 years. Blood pressure (BP) was measured at the research center and classified using the population-based percentiles. Sleep duration and related information were determined through questionnaires.

RESULTS

The prevalence of hypertension and prehypertension were 20.3% and 15%, respectively. The median sleep duration was 8.77 ± 1.07 hours (mean ± standard deviation). A short sleep duration (<9 hours) was associated with a higher risk of hypertension when compared with the group sleeping longer (9-10 h), among boys age 11 to 14 years old (OR, 1.5; 95% CI, 1.04-2.15), adjusting for age, body mass index, waist circumference, and physical activity. The linear regression stratified by age indicated that for boys age 11 to 14 years the inverse association existed after adjustment with the coefficients -1.04 mm Hg and -0.55 mm Hg per hour of sleep for systolic BP and diastolic BP, respectively.

CONCLUSIONS

Short sleep duration (<9 h) is independently associated with hypertension among Chinese boys age 11 to 14 years old.

Gender-specific association of sleep duration with blood pressure in rural Chinese adults

BACKGROUND

There are limited data about the role of gender on the relationship between sleep duration and blood pressure (BP) from rural populations.

METHODS

We conducted a cross-sectional rural population-based study. This report includes 1033 men and 783 women aged 18-65 years from a cohort of twins enrolled in Anhui, China, between 2005 and 2008. Sleep duration was derived from typical bedtime, wake-up time, and sleep latency as reported on a standard sleep questionnaire. Primary outcomes included measured systolic blood pressure (SBP) and diastolic blood pressure (DBP). High blood pressure (HBP) was defined as SBP ⩾130 mmHg, DBP ⩾85 mmHg, or physician diagnosed hypertension. Linear and logistic regression models were used to assess gender-specific associations between sleep duration and BP or HBP, respectively, with adjustment for known risk factors including adiposity and sleep-related disorder risk from the questionnaires. Generalized estimating equations were used to account for intra-twin pair correlations.

RESULTS

Compared with those sleeping 7 to <9h, women sleeping <7h had a higher risk of HBP (odds ratios [ORs] 3.0, 95% confidence interval [CI], 1.4-6.6); men sleeping ⩾9h had a higher risk of HBP (ORs=1.5, 95%CI: 1.1-2.2).

CONCLUSIONS

Among rural Chinese adults, a gender-specific association of sleep duration with BP exists such that HBP is associated with short sleep duration in women and long sleep duration in men. Longitudinal studies are needed to further examine the temporal relationship and biological mechanisms underlying sleep duration and BP in this population. Our findings underscore the potential importance of appropriate sleep duration for optimal blood pressure.

Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence

Laboratory studies have found that short-term sleep restriction is associated with impairments in glucose metabolism, appetite regulation and blood pressure regulation. This chapter reviews the epidemiologic evidence for an association between habitual sleep duration and quality and risk of cardiometabolic diseases including obesity, diabetes and hypertension. Multiple studies observed a cross-sectional association between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes and prevalent hypertension. Many studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. There have been a few prospective studies and several, but not all, have found an association between short sleep and incident diabetes, hypertension and markers of cardiovascular disease. Future prospective epidemiologic studies need to include objective measures of sleep, and intervention studies are needed in order to establish a causal link between impaired or insufficient sleep and cardiometabolic disease risk.

Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy

STUDY OBJECTIVES

We evaluated the influence of maternal self-reported habitual sleep duration during early pregnancy on blood pressure (BP) levels and risk of hypertensive disorders of pregnancy.

DESIGN

Prospective cohort study.

SETTING

Clinic-based study.

PARTICIPANTS

A cohort of 1,272 healthy, pregnant women.

MEASUREMENTS AND RESULTS

We abstracted maternal antenatal BP values from medical records and estimated mean BP differences across hours of sleep categories in regression models, using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (95% CIs) for pregnancy induced hypertension (PIH) and preeclampsia (PE) in relation to long and short sleep duration were estimated. Mean 1st and 2nd trimester systolic (S) and diastolic (D) BP values were similar among women reporting to be short sleepers (< or = 6 h) vs. women reporting to sleep 9 hours. However, both short and long sleep duration in early pregnancy were associated with increased mean 3rd trimester SBP and DBP. For example, mean 3rd trimester SBP was 3.72, and 2.43 mm Hg higher for women reporting < or = 6 h and 7-8 h sleep, respectively, compared with women reporting 9 h of sleep. Mean 3rd trimester SBP was 4.21 mm Hg higher for women reporting long sleep (> or = 10 h) vs. the reference group. Short and long sleep durations were associated with increased risks of PIH and PE. The ORs for very short (< 5 h) and long (> or = 10 h) sleepers were 9.52 (95% CI 1.83 to 49.40) and 2.45 (95% CI 0.74 to 8.15) for PE.

CONCLUSIONS

Our findings are consistent with a larger literature that documents elevated blood pressure and increased risks of hypertension with short and long sleep duration.

Association between sleep and blood pressure in midlife: the CARDIA sleep study

BACKGROUND

Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.

METHODS

This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.

RESULTS

After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex, shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05). Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78). Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP. Sleep duration appeared to mediate the difference between African Americans and whites in DBP change over time (P = .02).

CONCLUSION

Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.