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Cited by 1,284Sleep and related disordersBlood Pressure and Hypertension StudiesObstructive Sleep Apnea Research

Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey

Gangwisch, James E., Heymsfield, Steven B., Boden-Albala, Bernadette, Buijs, Ruud M., Kreier, Felix, Pickering, Thomas G., Rundle, Andrew G., Zammit, Gary K. +1 more·2006·Hypertension
DOI 10.1161/01.hyp.0000217362.34748.e0
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Abstract

Depriving healthy subjects of sleep has been shown to acutely increase blood pressure and sympathetic nervous system activity. Prolonged short sleep durations could lead to hypertension through extended exposure to raised 24-hour blood pressure and heart rate, elevated sympathetic nervous system activity, and increased salt retention. Such forces could lead to structural adaptations and the entrainment of the cardiovascular system to operate at an elevated pressure equilibrium. Sleep disorders are associated with cardiovascular disease, but we are not aware of any published prospective population studies that have shown a link between short sleep duration and the incidence of hypertension in subjects without apparent sleep disorders. We assessed whether short sleep duration would increase the risk for hypertension incidence by conducting longitudinal analyses of the first National Health and Nutrition Examination Survey ( n =4810) using Cox proportional hazards models and controlling for covariates. Hypertension incidence ( n =647) was determined by physician diagnosis, hospital record, or cause of death over the 8- to 10-year follow-up period between 1982 and 1992. Sleep durations of ≤5 hours per night were associated with a significantly increased risk of hypertension (hazard ratio, 2.10; 95% CI, 1.58 to 2.79) in subjects between the ages of 32 and 59 years, and controlling for the potential confounding variables only partially attenuated this relationship. The increased risk continued to be significant after controlling for obesity and diabetes, which was consistent with the hypothesis that these variables would act as partial mediators. Short sleep duration could, therefore, be a significant risk factor for hypertension.

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  • Individuals with obstructive sleep apnea or insomnia are at significantly greater risk for cardiovascular and cerebrovascular diseases and metabolic disorders.

    “Population-based studies show that individuals with OSA or insomnia are at significantly greater risk for CVD and cerebrovascular diseases (eg, arrhythmias, atherosclerosis, coronary heart disease [CHD], heart failure, hypertension, and stroke) and metabolic disorders (eg, obesity, type 2 diabetes mellitus, and dyslipidemia).”

    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 [9]

  • 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 Gangwisch et al., 2006

  • In NHANES, short sleepers (≤5 hours per night) had increased odds of incident hypertension over 8-10 years (OR 1.32, 95% CI 1.02-1.71) compared to those reporting sleeping 7-8 hours per night after adjusting for numerous potential confounders.

    “Analysis of the National Health and Nutrition Examination Survey (NHANES) data in the US found that short sleepers (≤5 hours per night) had increased odds of incident hypertension over 8–10 years (OR 1.32, 95% CI 1.02–1.71) compared to those reporting sleeping 7–8 hours per night after adjusting for numerous potential confounders [209].”

    From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [209]

  • Sympathetic activity is increased in sleep deprivation, restless leg syndrome, and obstructive sleep apnea.

    “Sympathetic activity is also increased in sleep deprivation, restless leg syndrome, and OSA.252–254”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [254]

  • The mechanism of poor sleep quality contributing to elevated blood pressure and paroxysmal bouts of very high blood pressure relates to activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system.

    “The mechanism of poor sleep quality contributing to elevated BP and paroxysmal bouts of very high BP relates to activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system.252–255”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [254]

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Cites

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Authors
Gangwisch, J. E., Heymsfield, S. B., Boden-Albala, B., Buijs, R. M., Kreier, F., Pickering, T. G., Rundle, A. G., Zammit, G. K., & Malaspina, D.
Affiliations
Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-05
Volume
47
Issue
5
Pages
833-839
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/01.hyp.0000217362.34748.e0
OpenAlex
W2157422098
Cited by
1,284
References
5
Citations by year
2026: 27 · 2025: 47 · 2024: 51 · 2023: 49 · 2022: 61 · 2021: 65 · 2020: 66 · 2019: 82 · 2018: 70 · 2017: 66 · 2016: 68 · 2015: 88 · 2014: 75 · 2013: 89 · 2012: 76
FWCI
66.85
Type
journal article
Language
en
Open access
closed
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • KNAW research portal (Royal Academy of Art and Sciences (KNAW)) (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • KNAW Research Portal (The Royal Netherlands Academy of Arts and Sciences) (submittedVersion)
Funders
National Institute of Mental Health (T32MH013043)
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
short sleep duration, hypertension incidence, sleep deprivation, blood pressure, sympathetic activity, salt retention, cardiovascular risk factors, obesity, diabetes mellitus, sleep disorders, NHANES cohort
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Humans, Hypertension, Male, Middle Aged, Nutrition Surveys, Risk Factors, Sleep, Sleep Deprivation, Time Factors, Incidence, Proportional Hazards Models

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