Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study
Open accessAbstract
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.
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Racial differences in 5-year blood pressure change were explained by differences in sleep duration.
“Knutson and colleagues(236) found that racial differences in 5-year blood pressure change were explained by differences in sleep duration.”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [236]
Several studies have shown that the relationship between sleep and cardiometabolic disease risk does depend on race/ethnicity.
“Although this has not yet been directly tested, several studies have shown that the relationship between sleep and cardiometabolic disease risk does depend on race/ethnicity.”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [236]
The best examples of investigations in this area use mediational analysis to show that changes in sleep account for changes in health outcomes across groups, such as blood pressure.
“However, there is a lack of interventional studies that can demonstrate this; rather, the best examples of investigations in this area use mediational analysis to show that changes in sleep account for changes in health outcomes across groups, such as blood pressure.269”
From Sleep, Health, and Society (2017) · cites this paper as [269]
Insomnia symptoms are associated with hypertension in the population.
“Several studies have shown that insomnia symptoms are associated with hypertension in the population duration (Gangwisch et al., 2006; Gangwisch et al., 2010b; Knutson et al., 2009; Phillips & Mannino, 2007; Suka et al., 2003)”
From Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease? (2014) · cites this paper as Knutson et al., 2009
In that study, shorter sleep was associated with incident coronary artery calcification (OR = 0.67 per hour, p=.011; 95% CI 0.49-0.91).
“and incident coronary artery calcification (OR = 0.67 per hour, p=.011; 95% CI 0.49–0.91)”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [207]
In one study of adults aged 35-50 using wrist actigraphy, shorter sleep duration and lower sleep quality were both associated with higher blood pressure.
“In one study that recorded wrist actigraphy among adults aged 35–50 years, shorter sleep duration and lower sleep quality were both associated with higher blood pressure [207].”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [207]
In adults aged 35-50 with actigraphy-estimated sleep duration, shorter sleep was significantly associated with incident hypertension over 5 years (OR 0.72; 95% CI 0.55-0.95).
“In the study of adults aged 35–50 years that estimated sleep duration using actigraphy, shorter sleep was significantly associated with incident hypertension over 5 years (OR 0.72; 95% CI: 0.55, 0.95) [207]”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [207]
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References 34 · Cited by 403
Research works printed but not linked: 1
- [10]Houyez F Degoulet P Cittee J Sommeil et hypertension artérielle Arch Mal Coeur Vaiss 1990 83 8 1085 8 2124445
- Authors
- Knutson, K. L., Van Cauter, E., Rathouz, P. J., Yan, L. L., Hulley, S. B., Liu, K., & Lauderdale, D. S.
- Affiliations
- University of Chicago (US)
- Northwestern University (US)
- University of California, San Francisco (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-06-08
- Volume
- 169
- Issue
- 11
- Pages
- 1055
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC2944774
- OpenAlex
- W1976234290
- Cited by
- 403
- References
- 34
- Citations by year
- 2026: 7 · 2025: 22 · 2024: 28 · 2023: 14 · 2022: 23 · 2021: 23 · 2020: 26 · 2019: 25 · 2018: 21 · 2017: 23 · 2016: 31 · 2015: 27 · 2014: 27 · 2013: 37 · 2012: 33
- FWCI
- 28.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95095-66-0-1, n01hc48050-59-0-1, n01hc48048-58-0-1, n01hc48047-55-0-1, n01hc48049-61-0-1)
- National Institute on Aging (P01AG011412, AG-11412)
- National Heart, Lung, and Blood Institute (N01HC48050, N01 HC 95095, N01 HC048048, N01-HC-048049, NO1-HC-48049, N01 HC095095, N01 HC048050, N01-HC48048, N01-HC-48-049, N01 HC048047, NO1-HC-95095, N01-HC-480-47)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- sleep duration, blood pressure, hypertension, sleep maintenance, sleep quality, middle-aged adults, African Americans, racial differences, systolic blood pressure, diastolic blood pressure, hypertension incidence, snoring, daytime sleepiness, actigraphy
- MeSH terms
- Adult, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Sleep
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