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Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, Moreira BDS, Cimarosti HI, de Avelar NCP. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med 2024; 119:118-134. [PMID: 38669835 DOI: 10.1016/j.sleep.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil; Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Gabriela Zurman
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Felipe Vogel
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daiana Vieira Sutil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Ana Lúcia Danielewicz
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Iturvides Cimarosti
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Nurrobi YAS, Winston K, Damara I, Rahman AL, Falakhi MF, Aristya MP, Toaha AF, Larasaty IN. The Effect of Sleep Duration on Hypertension Risk in an Adult Asian Population: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61508. [PMID: 38957247 PMCID: PMC11218897 DOI: 10.7759/cureus.61508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 07/04/2024] Open
Abstract
Sleep duration has been proposed as a potential and important modifiable risk factor, yet its precise relationship with hypertension among Asian adults remains unclear. This meta-analysis aims to elucidate the impact of short sleep duration on hypertension risk within the adult Asian population. A systematic search of databases, including PubMed, Scopus, and ScienceDirect, was conducted to identify relevant studies published up to January 4, 2024. Eligible studies comprised observational cohort studies and cross-sectional studies that compared short sleep duration to normal sleep duration in relation to hypertension risk among Asian adults. The definitions for short and normal sleep durations were derived from the respective studies. The random effects model was utilized to pool effect estimates, and all statistical analyses were conducted using Review Manager 5.4 software (RevMan) (Cochrane Collaboration, Oxford, UK). Results from a systematic search obtained seven studies assessing sleep duration and hypertension risk in Asian populations. Based on a meta-analysis of six studies, short sleep duration is associated with a higher hypertension risk when compared to normal sleep duration (OR: 1.36; 95% CI: 1.13-1.64; p: 0.0010; I2: 75%). Subgroup analysis based on sex showed that the association is evident across males (OR: 1.12; 95% CI: 1.01-1.25; p: 0.03; I2: 64%) and females (OR: 1.22; 95% CI: 1.10-1.35; p: 0.0003; I2: 82%). In conclusion, based on the analyzed studies, short sleep duration is associated with a higher mild risk of hypertension, irrespective of sex. Thus, short sleep duration can be a modifiable risk factor that can be prevented to reduce the risk of hypertension. By incorporating sleep hygiene practices and promoting healthy sleep habits, significant improvement in cardiovascular health can be made, especially in hypertension risk at a population level. Further studies on the effect of sleep duration in different age populations should be conducted to confirm the impact of short sleep duration.
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Affiliation(s)
- Yusuf Aji S Nurrobi
- Cardiology, Pertamina Hospital, Balikpapan, IDN
- Cardiology, Faculty of Medicine, Universitas Airlangga, Surabaya, IDN
| | - Kevin Winston
- Hospital Medicine, Bhakti Medicare Hospital, Cicurug, IDN
| | - Ivan Damara
- Research, Oxford University Clinical Research Unit Indonesia, Jakarta, IDN
| | - Andi L Rahman
- General Medicine, Hasri Ainun Habibie Regional Hospital, Parepare, IDN
| | - Moh F Falakhi
- General Medicine, Muhammadiyah Gresik Hospital, Gresik, IDN
| | - Meutia P Aristya
- General Medicine, Metropolitan Medical Centre Hospital, Jakarta, IDN
| | - Ahmad F Toaha
- General Medicine, Labuang Baji Hospital, Makassar, IDN
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Hou Z, Chen Y, Sun Y, Song C, Deng H, Cheng N, Han X, Zhang J, Wang Q, Li Y, Yin J, Meng Q. Sleep Duration and Insomnia with Comorbid Depression and Anxiety Symptoms in Chinese Adults: A Cross-Sectional Study. Nat Sci Sleep 2023; 15:1079-1091. [PMID: 38146513 PMCID: PMC10749553 DOI: 10.2147/nss.s440584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose Depression and anxiety are two highly prevalent mental disorders that commonly coexist. However, little is known about the association between sleep and comorbid depressive and anxiety symptoms (CDAS). Therefore, this study aims to explore the relationship between sleep duration, insomnia and CDAS. Methods This is a cross-sectional study of 22,004 community adults who participated in the China Multi-Ethnic Cohort (CMEC) study. Chinese version of Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen CDAS in community adults. A positive score on each scale was considered indicative of CDAS. All participants received face-to-face interviews, medical examinations, and biochemical examinations to assess sleep duration and insomnia and collect covariates. The self-reported sleep duration was divided into three groups: <7 hr, 7-9 hr and >9 hr groups. Logistic regression was used to analyze the association between sleep duration, insomnia and CDAS. A restricted cubic spline (RCS) was used to explore the dose-response relationship between sleep duration and CDAS. Stratified analysis based on gender and age was conducted. Results Overall, 2.8% (95% CI 2.6%~3.0%) of participants reported having CDAS. After adjusting the potential covariates, sleep duration <7 hr (OR=1.635, 95% CI=1.335~2.004) was significantly associated with CDAS, compared with sleep 7-9 hr. After RCS analysis, there was a nonlinear relationship between sleep duration and CDAS. The increase in the number of types of insomnia, the greater the likelihood of CDAS (p for trend<0.05). In sensitivity analysis, it was found that the results were consistent with those of the main analysis. After stratification by gender and age, the association between sleep duration and CDAS was only observed in female and young and middle-aged adults, not in men and older adults. Conclusion Both insufficient sleep duration and insomnia are associated with a higher prevalence of CDAS in Chinese adults.
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Affiliation(s)
- Zhongxin Hou
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Yang Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
- Institute for Acute Communicable Disease Prevention and Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, People’s Republic of China
| | - Yunrui Sun
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Chongwei Song
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Haoyuan Deng
- Medical Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Nan Cheng
- Department of Hospital Infection, Wuhan Mental Health Center, Wuhan, Hubei, People’s Republic of China
| | - Xiaoyu Han
- Institute for Acute Communicable Disease Prevention and Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, People’s Republic of China
| | - Jianghui Zhang
- AIDS Care Center, Yunnan Provincial Hospital of Infectious Disease, Anning, Yunnan, People’s Republic of China
| | - Qian Wang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Yi Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Jianzhong Yin
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
- Baoshan College of Traditional Chinese Medicine, Baoshan, Yunnan, People’s Republic of China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
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Xu W, Fang J, Chen L, Wang D, Huang C, Huang T, Guo C. Unraveling the Nexus: Exploring the Relationship between Exercise Habits and Sleep Quality in Older Adults. Healthcare (Basel) 2023; 11:2759. [PMID: 37893835 PMCID: PMC10606692 DOI: 10.3390/healthcare11202759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
The objective of this study is to investigate the impact of exercise habits on enhancing the sleep quality of older adults. The Pittsburgh Sleep Quality Scale and other questionnaires were utilized to assess the sleep quality of older adults aged 60 years and above in the H district. The sampling method employed was stratified random sampling. To analyze the influencing factors of sleep quality, the average treatment effect was estimated, the robustness of the results was assessed and statistical methods such as Logit regression and propensity score matching were employed. The study revealed that exercise habits strongly correlated with improved sleep quality in the older adult (p < 0.05), with the average total sleep quality score being 6.22 (±3.53). It was observed that older adults who engaged in exercise habits experienced a significant 12.66% increase in the likelihood of achieving good sleep. This investigation highlights the positive association between exercise habits and enhanced sleep quality among older adults. Additionally, age, physical pain and self-rated health statuses were identified as significant factors influencing sleep quality in this population. To enhance the sleep quality of older adults, this article recommends promoting relevant exercise habits, thus contributing to their overall well-being and quality of life.
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Affiliation(s)
- Wenhu Xu
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Jianze Fang
- School of Business, Macau University of Science and Technology, Macau 999078, China;
| | - Long Chen
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing 100091, China
| | - Chengye Huang
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Tiange Huang
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
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Gu J, Wang Q, Qiu W, Lin F, Wu C, Hao M, Wu P. Prevalence of Hypertension and Associated Factors among Residents Aged ≥18 Years in Ganzhou, China: A Cross-Sectional Study. Int J Hypertens 2023; 2023:5486139. [PMID: 37841509 PMCID: PMC10569894 DOI: 10.1155/2023/5486139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Background Reliable epidemiologic data on the present burden of hypertension are needed in developing region-specific strategies since previous studies have suggested that China is lagging in risk factor management. Objective The study aimed at exploring the prevalence of hypertension and its associated factors among adult residents in Ganzhou, China. Methodology. A multistage, stratified, and cluster random sampling method was used to conduct the cross-sectional survey. The study selected four county-level districts in Ganzhou City, China, as the investigation area. Permanent residents aged ≥18 years who have settled in the area for 6 months or more were selected. A total of 7430 residents were involved in the study. Univariate and multivariate logistic regression analysis was carried out to identify predictors of hypertension. Results The prevalence of hypertension in Ganzhou was 28.5%, and the age-standardized prevalence of hypertension was 22.4%. Univariate logistic regression analysis revealed that multiple variables have a statistically significant effect on the prevalence of hypertension. The elderly (odds ratio [95% CI]: 2.791 [2.594-3.004]), men (1.805 [1.583-2.058]), lower educated (0.848 [0.805-0.893]), a family history of hypertension (4.575 [3.900-5.368]), higher body mass index (1.344 [1.215-1.488]), central obesity (1.532 [1.304-1.799]), and less vegetable intake (1.150 [1.023-1.294]) were the major risk factors for hypertension. Conclusion Hypertension is a major public health problem in Ganzhou and requires much effort to reduce its prevalence. An effective multifaceted implementation strategy is highly desirable to combat the emerging burden of hypertension.
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Affiliation(s)
- Junwang Gu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Qi Wang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Wei Qiu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Fen Lin
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Chunmei Wu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Ming Hao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Ping Wu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou 341000, Jiangxi, China
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Liang YY, Ai S, Xue H, Chen Y, Zhou J, Shu X, Weng F, Zhou M, Ma H, Zhang J, Geng Q, Wing YK. Joint Associations of Device-Measured Sleep Duration and Efficiency With All-Cause and Cause-Specific Mortality: A Prospective Cohort Study of 90 398 UK Biobank Participants. J Gerontol A Biol Sci Med Sci 2023; 78:1717-1724. [PMID: 37186145 DOI: 10.1093/gerona/glad108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Both sleep duration and efficiency are essential for health outcomes. However, few studies have considered the effects of both sleep duration and efficiency on predicting the risks of mortality. This study investigated the independent and joint associations of accelerometer-measured sleep duration and efficiency with all-cause and cause-specific mortality. METHODS The UK Biobank is a cohort study of over 500 000 individuals recruited between 2006 and 2010. This study included participants wearing wrist accelerometers for 7 consecutive days between February 2013 and December 2015. Mortality was ascertained by the national death registries. RESULTS Of the 90 398 participants (age, 62.4 [7.8] years, 43.5% male) who were included, 2 685 deaths were reported within a median follow-up duration of 6.4 years. Both accelerometer-measured short (adjusted hazard ratios, 1.27; 95% confidence interval [CI]: 1.11-1.45) and long sleep duration (adjusted hazard ratios, 1.16; 95% CI: 1.06-1.28) were positively associated with the risks of all-cause mortality. Lower sleep efficiency was associated with an increased risk of all-cause and cause-specific mortality. Significant interaction existed between accelerometer-measured sleep duration and efficiency for the risk of all-cause mortality (Pinteraction = .001), participants with long sleep duration and lower sleep efficiency had a double mortality risk compared with those with higher sleep efficiency and normal sleep duration (adjusted hazard ratios = 2.11; 95% CI: 1.44-3.09). CONCLUSIONS Accelerometer-measured short/long sleep duration and lower sleep efficiency were associated with increased risks of mortality. Sleep efficiency modified the effects of long sleep duration on survival.
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Affiliation(s)
- Yannis Yan Liang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Institute of Psycho-neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sizhi Ai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Huachen Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yilin Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiajin Zhou
- The Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province. Kunming, Yunnan, China
| | - Xinyue Shu
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Foqian Weng
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Mingqing Zhou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huan Ma
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Qingshan Geng
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
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Sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia. PLoS One 2022; 17:e0271072. [PMID: 35797273 PMCID: PMC9262207 DOI: 10.1371/journal.pone.0271072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Sleep plays an essential role in every individual’s life since it contributes greatly to their well-being and health. Poor sleep quality is one of the most common consequences of hypertension (HTN), which is a leading public health problem. In Ethiopia, it is the main health concern among hypertension patients. Thus, in the study area, there is limited information regarding the investigation of sleep quality among hypertension patients. Therefore, this study aimed to assess sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia.
Methods
An institution-based cross-sectional study was conducted among adult HTN patients from March 15/2021 to May 15/2021 in Northwest Amhara Regional State Referral Hospitals. A systematic random sampling method was used to select the study participants. A face-to-face interviewer-administered questionnaire with chart review was used. The Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality was used in this study. A binary logistic regression was used to see the association between dependent and independent variables. Variables having a p-value < 0.05 with a 95% CI were considered statistically significant in the multivariable logistic regression analysis.
Results
In this study, 563 hypertensive patients were included, with a response rate of 96.9%. The overall prevalence of poor sleep quality was 37.7% (95% CI: 33.4%–41.6%). Female gender (AOR = 2.55, 95% CI: 1.55–4.18), age ≥ 65 years (AOR = 4.07, 95% CI: 2.07–7.97), overweight (BMI) ≥ 25 kg/m2 (AOR = 1.68, 95% CI: 1.06–2.65), WHO stage II hypertension (AOR = 1.78, 95% CI:1.01–3.12), poor physical activity (AOR = 2.39, 95% CI:1.41–4.05), participants who had depression (AOR = 2.03,95% CI:1.24–3.34) and participants who had anxiety (AOR = 1.89, 95% CI: 1.16–3.03) were factors associated with poor sleep quality.
Conclusions
In this study, more than one-third of the study participants had poor sleep quality. Female gender, age ≥ 65 years, overweight (BMI) ≥ 25 kg/m2, stage II hypertension, physical inactivity, depression, and anxiety were all associated with poor sleep quality. Managing depression and anxiety disorders, encouraging physical activity, and providing health education about weight loss are all necessary for HTN patients.
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Ding L, Zhang L, Cui Y, Gong Q, Ma J, Wang Y, Sang H. The association of sleep duration and quality with depressive symptoms in older Chinese women. PLoS One 2022; 17:e0262331. [PMID: 35290372 PMCID: PMC8923433 DOI: 10.1371/journal.pone.0262331] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022] Open
Abstract
Poor sleep quality or short and long sleep duration are associated with many negative health outcomes, such as diabetes, hypertension, and fatigue, which may directly or indirectly correlate with poor mental health. Although, the association between sleep duration and quality, and depressive symptoms has been examined, the results of these studies were inconsistent and evidence specifically on older women is lacking. Therefore, we designed a cross-sectional study to evaluate the association between sleep duration and quality, and depressive symptoms in a relatively large sample of older Chinese women. The data were collected from 1,429 older women aged ≥60 years during bone-health examinations in Shanghai. Information on sleep duration and quality were assessed using a self-reported questionnaire. Depressive symptoms were assessed using the Zung self-rating depression scale (SDS), and depressive symptoms were considered present for SDS scores ≥ 45. Logistic regression models were used to analyze the association between sleep and depressive symptoms. After adjusting for all potential confounding factors, a J-shaped association was found between sleep duration and depressive symptoms. When a sleep duration of 6–8 hours was set as a reference, the odds ratios and 95% confidential intervals of short and long sleep duration were 1.31 (0.99, 1.73) and 2.10 (1.40, 3.16), respectively. Moreover, sleep quality was inversely associated with the prevalence of depressive symptoms (p for trend = 0.040). When the SDS cut-off score defining depressive symptoms was changed to 40 and 50, these associations were somewhat weakened, but the trend did not change. This study replicated and extended prior research findings that sleep duration and quality may influence mental health in older women.
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Affiliation(s)
- Liang Ding
- Department of Physical Education, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
- Institute of Exercise Epidemiology and Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, People’s Republic of China
- * E-mail: (LD); (LZ)
| | - Luyao Zhang
- Institute of Exercise Epidemiology and Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, People’s Republic of China
- * E-mail: (LD); (LZ)
| | - Yufei Cui
- Institute of Exercise Epidemiology and Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, People’s Republic of China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Qiang Gong
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jiameng Ma
- Faculty of Physical Education, Sendai University, Miyagi, Japan
| | - Yongxiang Wang
- Institute of Exercise Epidemiology and Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, People’s Republic of China
| | - Haiyun Sang
- Institute of Exercise Epidemiology and Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, People’s Republic of China
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Association between Sleep Duration and Hypertension among Adults in Southwest China. Glob Heart 2022; 17:10. [PMID: 35342697 PMCID: PMC8877812 DOI: 10.5334/gh.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to evaluate the association between sleep duration and hypertension among adults in southwest China. Methods: Baseline variables were collected from a representative sample of 20,053 adults aged 23–98 years in southwest China who received physical examinations from January 2019 to December 2020. All participants were categorized into either a hypertension group or a non-hypertension group. Sleep duration was classified as short (<6 h/day), normal (6–8 h/day),or long (>8 h/day). Baseline variables were compared between individuals with and without hypertension by rank-sum tests for two independent samples or χ2 tests for nonparametric data. Multivariate logistic regression analysis was performed to evaluate the association between sleep duration and hypertension. Results: The overall incidence of hypertension was 51.2%. Unadjusted analysis showed that the risk of hypertension was higher in individuals with short (<6h/day) or long (>8h/day) sleep durations compared with those with a normal (6–8 h/day) sleep duration. The risk of hypertension was significantly increased by 30.1% in participants with a long (>8h/day) sleep duration compared with those with a normal (6–8h/day) sleep duration (OR = 1.301, P < 0.010, 95%CI = 1.149–1.475). The risk of hypertension was also increased by 1.1% in participants with a short (<6h/day) sleep duration compared with participants with a normal (6–8h/day) sleep duration, but the difference was not significant (OR = 1.011, P = 0.849, 95%CI = 0.905–1.129). After fully adjusting for confounding factors (model 4), the risk of hypertension was increased significantly (by 25%) in individuals with a short (<6h/day) sleep duration (OR = 1.25, P = 0.02, 95%CI = 1.036–1.508) but not in those with a long (>8h/day) sleep duration (17.5% increase) compared with participants with a normal (6–8h/day) sleep duration (OR = 1.175, P = 0.144, 95%CI = 0.946–1.460). Conclusion: The results of this study indicate that a short (<6h/day) sleep duration is related to an increased risk of hypertension, suggesting that sleep helps to protect against hypertension.
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Yang F, Zhang Y, Qiu R, Tao N. Association of sleep duration and sleep quality with hypertension in oil workers in Xinjiang. PeerJ 2021; 9:e11318. [PMID: 33987006 PMCID: PMC8101473 DOI: 10.7717/peerj.11318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study is to explore sleep status and hypertension among oil workers in Xinjiang, China. It may provide new ideas and basis for the precise prevention and treatment of hypertension in occupational population. Methods Sleep status and hypertension were investigated in 3,040 workers by a multi-stage cluster sampling method in six oil field bases in Karamay City, Xinjiang. The Pittsburgh Sleep Quality Index was used to evaluate the sleep status of workers. Logistic regression was used to analyze the relationship between sleep duration and sleep quality, and hypertension. Stratified analysis was also performed. Results Our results show: 1. Insufficient sleep duration (OR = 1.51, 95% CI [1.19–1.90]) and poor sleep quality (OR = 1.78, 95% CI [1.33–2.38] were positively associated with hypertension. 2. Stratified analysis indicated insufficient sleep duration was associated with increased risk of hypertension in females (OR = 1.54, 95% CI [1.16–2.04]) than males (OR = 1.49, 95% CI [1.00–2.23]), and the risk of hypertension in the group <30 years old (OR = 9.03, 95% CI [2.32–35.15]) was higher than that in the group of 30–45 years old (OR = 1.59, 95% CI [1.14–2.20]). However, in the group > 45 years old, sleeping > 8 h was associated with increased risk of hypertension (OR = 3.36, 95% CI [1.42–7.91]). Oil workers doing shift work had a higher risk of hypertension (OR = 1.55, 95% CI [1.16–2.07]) to no shift work (OR = 1.48, 95% CI [1.02–2.15]). The risk of hypertension in the group with < 10 years of service (OR = 4.08, 95% CI [1.92–8.83]) was higher than that in the group with length of service of 10–20 years (OR = 2.79, 95% CI [1.59–4.86]). Poor sleep quality was associated with risk for hypertension in females (OR = 1.78, 95% CI [1.26–2.49]), those doing shift work (OR = 1.70, 95% CI [1.17–2.47]), those with length of service of > 20 years (OR = 1.64, 95% CI [1.18–2.27]). The risk of hypertension in the group 30–45 years old is higher than that in the group > 45 years old (OR30–45 years old = 1.71, 95% CI [1.10–2.66]; OR > 45 years old = 1.60, 95% CI [1.09–2.34]). Conclusion Insufficient sleep duration and poor sleep quality are the potential factors affecting hypertension in Xinjiang oil workers.
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Affiliation(s)
- Fen Yang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Yuanyue Zhang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Ruiying Qiu
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Ning Tao
- School of Public Health, Xinjiang Medical University, Xinjiang, China.,Clinical Postdoctoral Mobile Station, Xinjiang Medical University, Xinjiang, China
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Yang Z, Heizhati M, Wang L, Li M, Pan F, Wang Z, Abudureyimu R, Hong J, Yao L, Yang W, Liu S, Li N. Subjective Poor Sleep Quality is Associated with Higher Blood Pressure and Prevalent Hypertension in General Population Independent of Sleep Disordered Breathing. Nat Sci Sleep 2021; 13:1759-1770. [PMID: 34675724 PMCID: PMC8517633 DOI: 10.2147/nss.s329024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/04/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore the relationship of subjective sleep quality with blood pressure (BP) and hypertension by considering the influence of sleep disordered breathing (SDB) and age in the general population. METHODS We evaluated sleep quality using the Pittsburgh sleep quality index (PSQI) and SDB using NoSAS score and measured BP in randomly selected adults in China in 2019. Sleep quality is categorized into four groups as very good, fairly good, fairly bad and very bad. SDB is defined as NoSAS score ≥8. Hypertension is defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, and/or use of antihypertensive medicine within previous 2 weeks. Multi-variable linear and logistic regression analyses were used to assess the association of global PSQI score and sleep quality with BP and prevalent hypertension. RESULTS In the 33,341 participants (53.4% women, median age: 48 years), prevalence of hypertension significantly increased from very good to very bad sleepers in total (34.3 vs 42.6 vs 50.3 vs 58.5%), SDB (61.2 vs 68.3 vs 73.3 vs 75.5%) and non-SDB participants (26.8 vs 33.1 vs 40.1 vs 50.9%). In multiple linear regression, PSQI global score showed significant positive association with BP levels in total, SDB and non-SDB participants, consistent in sensitivity analysis by excluding participants who were taking antihypertensives, and in participants aged <60 years in age-stratified analysis. In multivariable logistic regression, odds ratio for presence of hypertension significantly increased from very good to very bad sleepers in total (1 vs 1.08 vs 1.22 vs 1.48), SDB (1 vs 1.17 vs 1.35 vs 1.28) and non-SDB participants (1 vs 1.05 vs 1.14 vs 1.53), consistent in participants aged <60 years. CONCLUSION Poor subjective sleep quality is significantly associated with higher BP and prevalent hypertension, independent of SDB in the young- and middle-aged general population, indicating potential of improving sleep quality to lower BP and optimize hypertension management at population level.
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Affiliation(s)
- Zhikang Yang
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Mulalibieke Heizhati
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Lin Wang
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Mei Li
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Fengyu Pan
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Zhongrong Wang
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Reyila Abudureyimu
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Jing Hong
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Ling Yao
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Wenbo Yang
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Shasha Liu
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
| | - Nanfang Li
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People's Republic of China
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Xiao M, Tang X, Zhang F, Zhou L, Bu X, Liu X, Ding X, Shen Z, Chen L, Wu Y, Tang W, Qiu J. Association between self-reported snoring and hypertension among Chinese Han population aged 30-79 in Chongqing, China. Environ Health Prev Med 2020; 25:78. [PMID: 33272209 PMCID: PMC7713023 DOI: 10.1186/s12199-020-00908-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background We aim to explore the association between self-reported snoring and hypertension among adults aged 30–79 in Chongqing, China. Methods A total of 23,342 individuals aged 30–79 were included at baseline from August 2018 to January 2019, and the final sample size for the analysis was 22,423. Face-to-face interviews and physical examinations were conducted by trained investigators. Logistic regression was performed to study age-specific and gender-specific associations between snoring and hypertension. Results Frequent snoring was associated with the risk of hypertension for each age and gender group, and the frequency of snoring was positively correlated with the risk for hypertension. For the three age groups (< 45, 45–59, ≥ 60), compared with the non-snoring group, those who snore often had a 64.5%, 53.3%, and 24.5% increased risk of hypertension (< 45: OR = 1.65, 95%CI 1.34–2.02; 45–59: OR = 1.53, 95%CI 1.37–1.72; ≥ 60: OR = 1.25, 95%CI 1.09–1.42), respectively. For men and women, those who snore often had a 46.8% and 97.2% increased risk of hypertension, respectively, than the non-snoring group (men: OR = 1.47, 95%CI 1.33–1.63; women: OR = 1.97, 95%CI 1.75–2.23). Conclusions People who snore frequently should pay close attention to their blood pressure levels in order to achieve early prevention of hypertension, particularly for snorers who are female and aged under 45; importance should be attached to their blood pressure control.
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Affiliation(s)
- Meng Xiao
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaojun Tang
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Fan Zhang
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Li Zhou
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoqing Bu
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Xiang Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xianbin Ding
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Zhuozhi Shen
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Liling Chen
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Yunyun Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Wenge Tang
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Jingfu Qiu
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
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Huang M, Yang Y, Huang Z, Yuan H, Lu Y. The association of nighttime sleep duration and daytime napping duration with hypertension in Chinese rural areas: a population-based study. J Hum Hypertens 2020; 35:896-902. [PMID: 32973309 DOI: 10.1038/s41371-020-00419-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 11/09/2022]
Abstract
We aimed to investigate the association of self-reported nighttime sleep duration and daytime napping duration with hypertension in rural areas of China. The participants, who were from rural areas of Hunan Province in China, were enrolled during 2016-2017. Nighttime sleep duration (<7 h, 7-8 h, and ≥9 h) and daytime napping duration(no nap, 0-1 h, and >1 h) were determined by a self-reported questionnaire. Hypertension was defined as a mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg or a self-reported physician diagnosis of hypertension and current use of antihypertensive medication. Of 1763 enrolled participants, 52% had hypertension. A total of 640 (36%) were male and 1123 (64%) were female; the mean age was 56 years. After adjusting for potential confounders, participants who slept for ≥9 h per night had a 1.29-fold (95% CI: 1.03, 1.60) increased odds of hypertension compared to the reference group (7-8 h per night). Daytime napping >1 h was negatively associated with hypertension, with an adjusted OR (95% CI) of 0.70 (0.51, 0.97), and the protective effect of longer daytime napping was still found in the subgroup sleeping 7-8 h per night. Among the rural population in China, long nighttime sleep duration is associated with a higher prevalence of hypertension, and longer daytime napping is related to a decreased prevalence of hypertension.
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Affiliation(s)
- Miao Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Yiping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Hong Yuan
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China. .,National-Local Joint Engineering Laboratory of Drug Clinical Evaluation Technology, Changsha, 410000, China.
| | - Yao Lu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China. .,National-Local Joint Engineering Laboratory of Drug Clinical Evaluation Technology, Changsha, 410000, China.
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14
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Kawada T. Sleep quality, sleep duration and hypertension. J Psychosom Res 2020; 136:110174. [PMID: 32619862 DOI: 10.1016/j.jpsychores.2020.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoyuiki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan.
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