Insomnia and sleep duration as mediators of the relationship between depression and hypertension incidence
Open accessAbstract
BACKGROUND: Depression has been found to predict the incidence of hypertension and other adverse cardiovascular events in prospective studies. Insomnia and short sleep duration, which are typical symptoms of depression, have also been shown to increase the risk for hypertension incidence. Insomnia is associated with increased activation of the hypothalamic-pituitary-adrenal axis, and short sleep duration raises average 24-h blood pressure, which over time could lead to structural adaptations that gradually reset the entire cardiovascular system to operate at an elevated pressure equilibrium. No previous published population studies have examined whether insomnia and sleep duration mediate the relationship between depression and hypertension incidence. METHODS: We conducted multivariate longitudinal (1982-1992) analyses stratified by age of the First National Health and Nutrition Examination Survey (NHANES I) (n = 4,913) using Cox proportional hazards models. RESULTS: Middle-aged subjects who suffered from depression at baseline were 44% more likely to be diagnosed with hypertension over the follow-up period after controlling for covariates (hazard ratio (HR) = 1.44, 95% confidence interval (CI) 1.15-1.80). Both short sleep duration and insomnia were also significantly associated with hypertension incidence. Consistent with insomnia and sleep duration acting as mediators of the relationship between depression and hypertension incidence, the inclusion of these variables in the multivariate models appreciably attenuated the association (HR = 1.27, 95% CI 1.00-1.61). Depression, sleep duration, and insomnia were not significantly associated with hypertension incidence in elderly subjects. CONCLUSIONS: These results suggest the hypothesis that treatment of sleep problems in middle-aged individuals suffering from depression could reduce their risk for developing hypertension, and its vascular and cardiac complications.
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Short self-reported sleep duration is associated with increased cross-sectional and longitudinal risk for depression, whether measured as symptoms or as a diagnosis.
“Short self-reported sleep duration is associated with increased cross-sectional and longitudinal risk for depression, whether measured as symptoms or as a diagnosis.77,79–84,86”
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References 36 · Cited by 168
Research works printed but not linked: 2
- [25]U.S. Department of Health and Human Services, National Center for Health Statistics National Health and Nutrition Examination Survey I: Epidemiologic Followup Study, 1982–1984, 1986, 1987, 1992 (Computer Files) 1992, 1996 Hyattsville, MD U.S. Department of Health and Human Services, National Center for Health Services (producer) Inter-university Consortium for Political and Social Research (distributor):Ann Arbor, MI, 1992, 1997.
- [27]Radloff LS Locke BZ Weissman MM Myers JK Ross CE The community mental health assessment survey and the CES-D scale Community Surveys of Psychiatric Disorders 1986 New Brunswick, NJ Rutgers University Press 177 189
- Authors
- Gangwisch, J. E., Malaspina, D., Posner, K., Babiss, L. A., Heymsfield, S. B., Turner, J. B., Zammit, G. K., & Pickering, T. G.
- Affiliations
- Columbia University (US)
- New York University (US)
- New York State Psychiatric Institute (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Clinilabs (United States) (US)
- Columbia University Irving Medical Center (US)
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-01-01
- Volume
- 23
- Issue
- 1
- Pages
- 62-69
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- PMC
- PMC4415616
- OpenAlex
- W2031448834
- Cited by
- 168
- References
- 36
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 8 · 2023: 9 · 2022: 13 · 2021: 12 · 2020: 9 · 2019: 10 · 2018: 13 · 2017: 7 · 2016: 11 · 2015: 9 · 2014: 16 · 2013: 6 · 2012: 18
- FWCI
- 13.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R24-HL76857, R24HL076857)
- 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
- insomnia, sleep duration, depression, hypertension incidence, mediation, middle-aged adults, cardiovascular risk, hypothalamic-pituitary-adrenal axis, NHANES I
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Depression, Female, Humans, Hypertension, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Middle Aged, Nutrition Surveys, Sleep, Time Factors, Incidence, Proportional Hazards Models
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