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

Excessive Daytime Sleepiness in Patients With Hypertension: A Systematic Review

We must remember that there are many subclinical cases of obstructive sleep apnea (OSA), even if the patient or family members typically become aware of it through symptoms such as snoring and excessive daytime sleepiness (EDS). EDS is a common symptom among hypertensive patients. This interesting and remarkable systematic review aims to comprehensively survey the current literature on the prevalence and association of EDS among hypertensive patients. PubMed, SCOPUS, Web of Science, and Science Direct were systematically searched for relevant literature. Rayyan QRCI (Rayyan Systems Inc., Cambridge, MA) was employed throughout this comprehensive process. This review included nine studies with a total of 58,517 patients, and 34,398 (58.8%) were males. EDS prevalence among hypertensive patients ranged from 12.1% to 88.3%. This review stated that individuals with hypertension (HTN) had EDS that was worse than that of patients with normotension. In one of the studies included in this analysis, sympathovagal imbalance was noted alongside EDS and HTN. Older age, primary education, being overweight, working, obesity, depression, and having had the condition for longer are all associated with EDS in HTN patients.

Association Between Sleep Quality and Hypertension in Chinese Adults: A Cross-Sectional Analysis in the Tianning Cohort

BACKGROUND

Poor sleep quality is becoming very common in a developed society and relates to many health disorders. However, the association between sleep quality and hypertension has not been well studied in Chinese adults.

METHODS

Blood pressure was measured and sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) for 5167 participants (mean aged 51±15 years, 41.5% males) in the Tianning Cohort. A logistic regression model was constructed to examine the association between sleep quality, as well as its components, and hypertension, adjusting for age, sex, education level, current smoking, current drinking, physical activity, obesity, glucose, and blood lipids.

RESULTS

After multivariate adjustment, a higher score Of the PSQI was significantly associated with an increased risk of prevalent hypertension (OR=1.03, P=0.018). Compared to participants with normal sleep (the PSQI score <5), those with a poor sleep quality (the PSQI score ≥5) had a 17% increased risk of prevalent hypertension (OR=1.17, P=0.042). Three of the seven components of sleep quality, such as subjective sleep quality (OR=1.17, P=0.001), sleep latency (OR=1.11, P=0.010), and sleep disturbances (OR=1.19, P=0.004), were also significantly associated with prevalent hypertension.

CONCLUSION

Poor sleep quality is increasingly prevalent in developed societies and may be related to an increased risk of hypertension in Chinese adults. The underlying causality is waiting to be studied.

Secondhand smoke is associated with poor sleep quality in self-reported never-smokers of Northwest China: a cross-sectional study

OBJECTIVE

To investigate the relationship between secondhand smoke (SHS) exposure and sleep quality in never-smokers of Northwest China.

METHODS

Never-smoking adults (≥ 15 years) from Xinjiang, Northwest China, were included in this cross-sectional survey between April and October 2019. SHS exposure in never-smokers was estimated using a structured questionnaire. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI), with PSQI score > 5 classified as poor sleep quality. Association of SHS exposure and frequency and duration of SHS exposure with poor sleep quality were analyzed by using a multivariate logistic regression after adjusting for potential confounding factors, including stratification by sex.

RESULTS

The mean age of participants was 48.0 years, and 77% were females. Of 21,198 never-smokers, 13% (n = 2703) reported SHS exposure and 35% (n = 7390) reported poor sleep quality. In multivariate logistic regression analysis, a significant association was observed between SHS exposure and poor sleep quality (adjusted odds ratio (OR), 1.36; 95% confidence interval (CI) 1.24-1.48). Subgroup analysis showed a negative association of SHS exposure with sleep quality in both sexes. However, a significant dose-response relationship of frequency and duration of SHS exposure per week with poor sleep quality was observed only in females. Consistent results were also observed in the aged ≥ 18 years.

CONCLUSION

Exposure to SHS is associated with poor sleep quality in never-smoking adults of Northwest China. A dose-response relationship between SHS exposure and poor sleep quality is found in women. Avoiding SHS exposure may have beneficial effects on sleep quality, especially for females.

Associations between sleep duration, shift work, and infectious illness in the United States: Data from the National Health Interview Survey

OBJECTIVE

Insufficient sleep and circadian disruption have been linked to immune system dysregulation. The aim of this study was to examine the associations between self-reported sleep duration and work schedule with reports of head and chest colds among adults 18 years and older in the United States.

METHODS

Associations between self-reported habitual sleep duration and work schedule (regular daytime, regular evening, regular nighttime, rotating, other) with reports head and chest colds in the past 2 weeks were examined using data from the 2010 and 2015 National Health Interview Survey. Adults who slept 7-8 hours or reported a regular daytime work schedule were considered the reference group. Multivariate logistic regressions, incorporating sampling weights, were computed adjusting for sociodemographic and health characteristics.

RESULTS

Analyses revealed in fully adjusted models that compared to 7- 8 hours sleepers, those sleeping 5 or fewer hours were 44% more likely to report a cold (odds ratio [OR] = 1.44, 95% confidence interval [CI] 1.29-1.61) while those sleeping 9 or more hours were 20% more likely (OR = 1.20, 95% CI 1.06-1.36). Participants who reported a rotating work schedule were 20% more likely to report a cold (OR = 1.20, 95% CI 1.07-1.36) than those reporting a regular daytime work schedule.

CONCLUSIONS

Short and long sleep duration, as well as a rotating shift work schedule, were associated with increased reports of head and chest colds in a nationally representative sample of US adults. Sleep and circadian function may serve as relevant targets to reduce susceptibility to infectious illness.

The age and gender effect on the association of sleep insufficiency with hypertension among adults in Greece

Background: We aimed to investigate the relationship between sleep characteristics with hypertension using self-reported questionnaires. Material & methods: A total of 957 adults were classified into three groups (short [<6 h], normal [6-8 h] and long [>8 h] sleepers). Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or use of antihypertensive medication at the time of interview. Results: Overall prevalence of hypertension was 34.3%. Association between short sleep duration and hypertension that was age-specific, present only among younger and middle aged individuals and sparing the elderly, but not gender-specific, as no discrepancies existed between males and females in all age groups, was evident. Conclusion: This study promotes early pharmacological or cognitive behavioral interventions on sleep disturbances in order to reduce hypertension burden.

Effect of Sleep Disturbances on Blood Pressure

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

Association between sleep disorders and shift work: a prospective cohort study in the Chinese petroleum industry

Objective. This study aimed to understand the prevalence of sleep disorders among shift workers and analyze the relationship between sleep disorders and shift work. Methods. Baseline data were collected from subjects who were then followed for 2 years in a prospective cohort study. The cohort ultimately included 2453 people starting in May 2013, and follow-up with questionnaires was performed in July 2014 and October 2015. Sleep disorders were assessed with the Pittsburgh sleep quality index. Results. The risk of sleep disorders among two-shift workers (relative risk [RR] = 1.318, 95% confidence interval [CI] [1.025, 1.695]), three-shift workers (RR = 1.326, 95% CI [1.048, 1.679]) and four-shift workers (RR = 1.334, 95% CI [1.062, 1.675]) was higher than that among non-shift workers, and an increasing trend was observed in sleep disorders as the number of shifts increased. Conclusions. Shift workers have a higher incidence of sleep disorders than non-shift workers. An increasing linear trend was observed between the number of shifts and sleep disorders. In the petroleum industry, it is necessary to decrease the frequency of shifts to reduce the incidence of sleep disorders among shift workers.

Pain and Psychological Distress: Effect of Microvascular Decompression on Sleep Disorders and Obsessions in Trigeminal Neuralgia

Objective  This study was aimed to investigate the effects of microvascular decompression (MVD) on sleep disorders and obsessions in trigeminal neuralgia. Methods  Clinical data from 115 patients with trigeminal neuralgia treated with MVD from August 1, 2017 to May 31, 2018 at Jining First People's Hospital were analyzed retrospectively. The preoperative and postoperative risk factors for sleep disorders and obsessions, as well as the effects of MVD on sleep disorders and obsessions, were examined. Results  In 115 patients, there were significant differences in preoperative sleep disorders associated with sex, monthly household income, pain in multiple branches, visual analog scale (VAS) score, and Self-Rating Depression Scale (SDS) score ( p  < 0.05). Preoperative obsessions were significantly different according to age, gender, pain in multiple branches, monthly household income, VAS score, and Self-Rating Anxiety Scale (SAS) score groups ( p  < 0.05). A 1-year recurrence was positively correlated with sleep disturbance (odds ratio = 3.829) and obsessions (odds ratio = 4.507). In addition, the results revealed a negative correlation between the manipulation of trigeminal neuralgia and postoperative sleep disorders ( B  ≥ 1.043). Moreover, there was a significant difference in sleep disorders and obsessions before and 1 year after MVD ( p  < 0.05). Conclusion  For patients with trigeminal neuralgia, pain caused by sleep and obsession disorders should be examined early to identify an effective solution. Moreover, MVD, as a first treatment, is valuable for improving the physiological and psychological prognosis of patients.

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.

Shift Workers Have Higher Blood Pressure Medicine Use, But Only When They Are Short Sleepers: A Longitudinal UK Biobank Study

Background

Some, but not all, studies report associations between shift work and hypertension, suggesting that particular subgroups may be at risk. We examined moderating effects of sleep duration and circadian preference on the relationship between shift work and new blood pressure (BP) medicine use at follow‐up.

Methods and Results

Baseline and 5‐year follow‐up data from the UK Biobank cohort (N=9200) were used to generate logistic regression models for shift workers and nonshift workers. The moderating effects of sleep duration (short ≤6 hours; adequate 7–8 hours; long ≥9 hours) and circadian preference (morning “larks;” intermediate; evening “owls”) at baseline were examined with new BP medicine use at follow‐up, adjusting for age, sex, race, education, employment, urban/rural, cardiovascular disease family history, depression, alcohol intake, physical activity, diet, smoking, and body mass index. The sample was predominately middle aged (55.3±7.4), female (57.3%), and white (97.9%). Most reported adequate sleep duration (7–8 hours, 73.7%) and were intermediate type (65.3%); 8.0% were shift workers at baseline. Only 6.5% reported new BP medicine use at follow‐up. Short sleep duration was a significant moderator of new BP medicine use in shift workers. Among short sleepers, shift workers had a 2.1‐fold increased odds of new BP medicine use compared with nonshift workers (odds ratio=2.08, 95% CI=1.21–3.58, P=0.008). In those reporting adequate (odds ratio=0.82, 95% CI=0.54–1.25, P=0.35) and long sleep (odds ratio=0.64, 95% CI=0.11–3.54, P=0.60), this relationship was protective but nonsignificant. Interaction between circadian preference and shift work on BP medicine use was nonsignificant.

Conclusions

Shift workers with short sleep duration may be at risk for hypertension.

Compliance with care and poor sleep quality among hypertensive adults in a mountainous area of Hubei Province, People's Republic of China

BACKGROUND

Little information is available concerning the relationship between compliance with hypertensive care and poor quality of sleep among Chinese adults in rural areas. This study aimed to evaluate the association between the compliance with hypertensive care and sleep quality for hypertension of adults in a mountainous area in People's Republic of China.

METHODS

A total of 551 hypertensive patients (30-96 years of age) living in a remote mountainous area were recruited. Poor sleep quality was assessed using the standard Pittsburgh Sleep Quality Index (PSQI), and compliance with care was measured based on the Compliance of Hypertensive Patients Scale (CHPS). Hypertension was defined as blood pressure ≥140/90 mmHg or treated with antihypertensive medication. The associations between sleep quality and compliance variables were examined using Pearson's correlation. Multiple linear regressions were established to verify significant variables associated with respondents' compliance with care and poor sleep quality.

RESULTS

The average age of the sample was 67.15 years (SD=10.20), and 56.44% of the participants were female. The mean CHPS total score was 41.97 (SD=5.91), and the PSQI total score was 7.91 on average (SD=4.10). Correlation analysis revealed that patients with higher intention, healthier lifestyle, positive attitude and total compliance were more likely to have an increased risk of poor sleep quality. According to the results of multiple linear regression analyses, hypertension compliance was significantly associated with being female, married, non-rural residence and years of hypertension, while poor sleep quality had a significant association with living in rural areas, having concomitant disease and poor hypertension compliance.

CONCLUSIONS

There is a significant association between hypertension compliance and poor sleep quality. Future intervention programs should focus on improving compliance behavior as a modifiable background factor for sleep quality.

Prevalence of sleep disturbances in Chinese healthcare professionals: a systematic review and meta-analysis

OBJECTIVE

The current review is a systematic, quantitative meta-analysis aimed at examining the pooled prevalence of sleep disturbances in Chinese healthcare professionals. Furthermore, we explore the possible causes of the inconsistencies in the current estimates.

METHODS

Systematic searches of databases were conducted for literature published on English (EMBASE, PubMed and Web of Science) and Chinese (Chinese National Knowledge Infrastructure, Wan Fang database and Chinese Science & Technology journal database) databases until 25 May 2018. Statistical analyses were performed using SPSS and R software, the prevalence of sleep disturbances was pooled using random-effects model.

RESULTS

A total of 52 studies with 31,749 participants were included. The pooled prevalence of sleep disturbances among Chinese healthcare professionals is 39.2% (95% CI: 36.0%-42.7%). Higher sleep disturbance rates are associated with being female, lower cut-off of Pittsburgh Sleep Quality Index (PSQI), later survey year, bigger sample size, the standardized assessment tool, being a nurse, and shift work. Sample size and cut-off of PSQI were significant moderators for heterogeneity.

CONCLUSION

Sleep disturbances are common in Chinese healthcare professionals, and their prevalence is much higher than the general population. Further research is needed to identify effective strategies for preventing and treating sleep disturbances among healthcare professionals.

The relationship between sleep disturbances and quality of life in elderly patients with hypertension

Purpose

Sleep disorders, such as insomnia with objective short sleep duration, are associated with increased risk of hypertension. The objective of the study was to evaluate the effects of insomnia and daytime sleepiness on the quality of life (QOL) among elderly hypertensive patients.

Patients and methods

This cross-sectional study covered 100 patients with hypertension. All participants completed standardized questionnaires, such as the Epworth Sleepiness Scale (ESS), the Athens Insomnia Scale (AIS), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF), and clinical data were obtained from patients' medical records.

Results

We showed that more than half of the patients experienced insomnia (AIS score ≥6) and 39% experienced daytime sleepiness. Daytime sleepiness was negatively associated with perceived QOL (r=-0.478, P<0.001). It was also shown that insomnia might be influenced by older age (P<0.001), occupational activity (P=0.011), overweight (body mass index [BMI] 25-30) (P=0.042), and longer duration of illness (P=0.049) among hypertensive patients.

Conclusion

Sleep problems have a significant negative impact on the QOL in patients with hypertension, especially in the physical domain of the QOL questionnaire. The occurrence of sleep problems in patients with hypertension is influenced by older age, primary education, overweight, occupational activity, and longer duration of illness.

Night shift work and abnormal liver function: is non-alcohol fatty liver a necessary mediator?

OBJECTIVES

Accumulated evidence implies that night shift work may trigger liver dysfunction. Non-alcoholic fatty liver (NAFL) is suggested to be a necessary mediator in this process. This study aimed to examine the relationship between night shift work and elevated level of alanine transaminase (e-ALT) of workers and investigate the potential mediation effect of NAFL.

METHODS

This study included all male workers from the baseline survey of a cohort of night shift workers. Information on demographics, lifestyle and lifetime working schedule was collected by face-to-face interview. Liver sonography was used to identify NAFL cases. Serum ALT level was detected by an automatic biochemical analyser. e-ALT was defined as ALT >40 U/L. Logistic regression models were used to evaluate ORs, and mediation analysis was employed to examine the mediation effect.

RESULTS

Among 4740 male workers, 39.5% were night shift workers. Night shift workers had an increased risk of e-ALT (OR, 1.19, 95% CI 1.00 to 1.42). With the increase in night shift years, the OR of e-ALT increased from 1.03 (95% CI 0.77 to 1.36) to 1.60 (95% CI 1.08 to 2.39) among workers without NAFL. A similar trend was not found among workers with NAFL. In addition, no significant mediation effect of NAFL in the association between night shift work and e-ALT was found.

CONCLUSIONS

Night shift work is positively associated with abnormal liver function, in particular among workers without NAFL. Shift work involving circadian disruption is likely to exert a direct effect on liver dysfunction rather than rely on the mediation effect of NAFL.

Night and rotational work exposure within the last 12 months and risk of incident hypertension

Objectives Shift work, such as alternating day and nights, causes chronobiologic disruptions which may cause an increase in hypertension risk. However, the relative contributions of the components of shift work ‒ such as shift type (eg, night work) and rotations (ie, switching of shift times; day to night) ‒ on this association are not clear. To address this question, we constructed novel definitions of night work and rotational work and assessed their associations with risk of incident hypertension. Methods A cohort of 2151 workers at eight aluminum manufacturing facilities previously studied for cardiovascular disease was followed from 2003 through 2013 for incident hypertension, as defined by ICD-9 insurance claims codes. Detailed time-registry data was used to classify each worker's history of rotational and night work. The associations between recent rotational work and night work in the last 12 months and incident hypertension were estimated using adjusted Cox proportional hazards models. Results Elevated hazard ratios (HR) were observed for all levels of recent night work (>0-5, >5-50, >50-95, >95-100%) compared with non-night workers, and among all levels of rotational work (<1, 1-10, >10-20, >20-30, and >30%) compared with those working <1% rotational work. In models for considering the combination of night and rotational work, workers with mostly night work and frequent rotations (≥50% night and ≥10% rotation) had the highest risk of hypertension compared to non-night workers [HR 4.00, 95% confidence interval (CI )1.69-9.52]. Conclusions Our results suggest recent night and rotational work may both be associated with higher rates of incident hypertension.

Prevalence of Hypertension in Professional Drivers (from the RACER-ABPM Study)

Professional drivers are a group exposed to many cardiovascular risk factors. Nonsystematic working hours, stress, low physical activity, and unhealthy dietary habits are common among professional drivers. These translate into high risk of cardiovascular disease. The aim of the current analysis was to establish the prevalence of arterial hypertension in a group of continuous professional drivers. The RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland) study is a prospective study focused on assessing cardiovascular risk factors in professional drivers. Patients included in the study were screened for the classical and nonclassical cardiovascular risk factors and had an ambulatory blood pressure monitoring (ABPM) performed. Of the RACER study population, 144 drivers were included into the RACER-ABPM study. Of this group 135 (95.7%) were male at mean age of 50.2 ± 9.3 years, with mean body mass index of 32.3 ± 3.0 kg/m². In 21.3% of patients, family history of cardiovascular disease was noted, 28.1% were current smokers, and 2.9% had diabetes mellitus. Arterial hypertension was previously diagnosed in 39 patients (27.9%). In ABPM, the mean 24-hour blood pressure (BP) values were 130.3 ± 14.3 and 80.9 ± 9.9 for systolic and diastolic BP, respectively, and 46.1% of patients could be categorized as dippers. Based on the ABPM results, arterial hypertension was diagnosed in 104 of patients (73.8%). Patients with hypertension tend to be more often male and have a family history of cardiovascular disease. In conclusion, arterial hypertension is highly prevalent in professional drivers. Also abnormal day-to-night BP value patterns are often seen in this group.

Exosomes and Metabolic Function in Mice Exposed to Alternating Dark-Light Cycles Mimicking Night Shift Work Schedules

Sleep is an important modulator of metabolic function. Disruptions of sleep in circadian rhythm are common in modern societies and are associated with increased risk of developing cardiometabolic disorders. Exosomes are ubiquitous extracellular vesicles that may play a mechanistic role in metabolic derangements. We hypothesized that alternating dark-light cycles mimicking shift work in mice would alter fecal microbiota and colonic epithelium permeability and alter plasma exosome cargo and metabolic function. C57BL/6 mice were randomly assigned to (i) control day light (CL), or (ii) inverted dark-light every 2 weeks for 8 weeks (IN). Body weight, fat mass and HOMA-IR were measured, along with Tregs, metabolic, and resident macrophages in visceral white adipose tissue (vWAT). Fecal water samples were incubated with confluent colonic epithelium cell cultures in electric cell-substrate impedance sensing (ECIS) arrays, and plasma exosomes were added to differentiated adipocytes and insulin-induced pAKT/AKT expression changes were assessed by western blots. Mice exposed to IN showed elevated HOMA-IR, and their fecal samples showed altered microbiota which promote increased permeability of the colonic epithelial cell barrier. Plasma exosomes decreased pAKT/AKT responses to exogenous insulin compared to CL, and altered expression of circadian clock genes. Inflammatory macrophages (Ly-6c^high) were increased in IN-exposed vWAT, while Tregs were decreased. Thus, gut microbiota and the cargo of plasma exosomes are altered by periodic shifts in environmental lighting, and effectively alter metabolic function, possibly via induction of systemic inflammation and altered clock expression in target tissues. Further exploration of exosomal miRNA signatures in shift workers and their putative metabolic organ cell targets appears warranted.