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Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey
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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“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]
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In the citing paper
“short sleep duration has been associated with risk for hypertension [45], incident coronary artery calcification [46], and mortality [47].”
From Loneliness matters: a theoretical and empirical review of consequences and mechanisms (2010) · cites this paper as [45]
In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“SBP, diastolic BP, and heart rate increase the day after a sleep-deprived night compared with the day after a normal sleep; urinary excretion of norepinephrine is also increased.56,253–256”
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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Apneic Sleep, Insufficient Sleep, and Hypertension
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Metadata
- 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
- Published
- 2006-05
- Volume
- 47
- Issue
- 5
- Pages
- 833-839
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2157422098
- Cited by
- 1,284
- References
- 6
- 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 (medical) › 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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