Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis
Abstract
Objectives We aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively.Methods We performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed.Results Twenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106 years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09-1.34; P<0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04-1.18; P=0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06-1.42; P=0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91-1.14; P=0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity.Conclusions Among adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor.
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Another meta-analysis found an association between both short and long sleep and hypertension in cross-sectional studies, but only for short sleep in longitudinal studies.
“In contrast, another meta-analysis found an association between both short and long sleep and hypertension in cross-sectional studies, but only for short sleep in longitudinal studies.63”
Two meta-analyses showed similar results without evidence of heterogeneity for short sleep duration and hypertension: RR=1.21 (95% CI, 1.05-1.40) based on 6 studies and RR=1.23 (95% CI, 1.06-1.42) based on 5 studies.
“Two showed similar results without evidence of heterogeneity (RR=1.21; 95% CI, 1.05–1.40 based on 6 studies94; and RR=1.23; 95% CI, 1.06–1.42 based on 5 studies95).”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [95]
Lower quality or quantity of sleep is linked to poorer physical health, including elevated risks for cardiovascular disease, hypertension, and early mortality.
“A substantial body of evidence indicates that lower quality or quantity of sleep is linked to poorer physical health,20–22 including elevated risks for cardiovascular disease,23 hypertension,24 and early mortality.25”
From Social Media Use and Its Link to Physical Health Indicators (2022) · cites this paper as [22]
Another meta-analysis found an association between both short and long sleep and hypertension in cross-sectional studies, but only for short sleep in longitudinal studies.
“In contrast, another meta-analysis found an association between both short and long sleep and hypertension in cross-sectional studies, but only for short sleep in longitudinal studies.63”
The relationship between self-reported sleep duration and prevalent hypertension follows a U-shaped association with the nadir of the U being between 7 and 8 hours of uninterrupted sleep per night.
“The relationship between self-reported sleep duration and prevalent hypertension follows a U-shaped association with the nadir of the U being between 7 and 8 hours of uninterrupted sleep per night.256,264,265”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [265]
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- Authors
- Guo, X., Zheng, L., Wang, J., Zhang, X., Zhang, X., Li, J., & Sun, Y.
- Affiliations
- First Hospital of China Medical University (CN)
- Sheng Jing Hospital (CN)
- Tongji University (CN)
- Corresponding author
- Sun, Yingxian
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 14
- Issue
- 4
- Pages
- 324-332
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W1969887065
- Cited by
- 327
- References
- 54
- Citations by year
- 2026: 5 · 2025: 34 · 2024: 30 · 2023: 24 · 2022: 21 · 2021: 31 · 2020: 21 · 2019: 29 · 2018: 27 · 2017: 25 · 2016: 23 · 2015: 21 · 2014: 29 · 2013: 6
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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, hypertension, short sleep duration, long sleep, U-shaped relationship, cardiovascular risk factors, lifestyle factors, adults
- MeSH terms
- Blood Pressure, Humans, Hypertension, Sleep, Sleep Wake Disorders
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