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Cited by 167Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

Objective but Not Subjective Short Sleep Duration Associated with Increased Risk for Hypertension in Individuals with Insomnia

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Bathgate, Christina J., Edinger, Jack D., Wyatt, James K., Krystal, Andrew D.·2016·Sleep
DOI 10.5665/sleep.5748PMC PMC4835301
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Abstract

To examine the relationship between hypertension prevalence in individuals with insomnia who have short total sleep duration < 6 h or sleep duration ≥ 6 h, using both objective and subjective measures of total sleep duration. Using a cross-sectional, observational design, 255 adult volunteers (n = 165 women; 64.7%) meeting current diagnostic criteria for insomnia disorder (MAge = 46.2 y, SDAge = 13.7 y) participated in this study at two large university medical centers. Two nights of polysomnography, 2 w of sleep diaries, questionnaires focused on sleep, medical, psychological, and health history, including presence/absence of hypertension were collected. Logistic regressions assessed the odds ratios of hypertension among persons with insomnia with short sleep duration < 6 h compared to persons with insomnia with a sleep duration ≥ 6 h, measured both objectively and subjectively. Consistent with previous studies using objective total sleep duration, individuals with insomnia and short sleep duration < 6 h were associated with a 3.59 increased risk of reporting hypertension as a current medical problem as compared to individuals with insomnia with sleep duration ≥ 6 h. Increased risk for hypertension was independent of major confounding factors frequently associated with insomnia or hypertension. No significant risk was observed using subjectively determined total sleep time groups. Receiver operating characteristic curve analysis found that the best balance of sensitivity and specificity using subjective total sleep time was at a 6-h cutoff, but the area under the receiver operating characteristic curve showed low accuracy and did not have good discriminant value. Objectively measured short sleep duration increased the odds of reporting hypertension more than threefold after adjusting for potential confounders; this relationship was not significant for subjectively measured sleep duration. This research supports emerging evidence that insomnia with objective short sleep duration is associated with an increased risk of comorbid hypertension. Insomnia and hypertension are highly prevalent medical concerns; practitioners should be aware that patients with untreated chronic insomnia may also have comorbid hypertension. Previous research found an association between objective short sleep duration (< 6 h per night) and increased risk for comorbid hypertension; this study replicates and extends these previous findings using a different population. Additionally, we examine differences between using objective and subjective measures of sleep to evaluate associated hypertension risk. The current study found that insomnia with objective short sleep was associated with a 3.59 increased risk of reporting hypertension, regardless of age, sex, race, weight, frequency of sleep medication use, sleep disordered breathing, daytime sleepiness, diabetes, high cholesterol, depression, and consumption of alcohol, caffeine, and tobacco.

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  • Performance did not return to baseline levels after a single night with a 10-h sleep opportunity or three nights with an 8-h sleep opportunity, suggesting that a longer recovery sleep period is needed to fully resolve performance decrements due to experimental sleep deficiency.

    “performance did not return to baseline levels after a single night with a 10-h sleep opportunity (28) or three nights with an 8-h sleep opportunity (32), suggesting that a longer recovery sleep period is needed to fully resolve any performance decrements due to experimental sleep deficiency”

    From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [32]

  • Recent work from the Penn State Adult Cohort has shown a synergistic effect between insomnia and PSG-measured short sleep duration (<6 hours) on the risk for hypertension and type-2 diabetes even after controlling for multiple confounders, including sleep-disordered breathing.

    “Based on the physiologic mechanisms reviewed above, recent work from the Penn State Adult Cohort has shown a synergistic effect between insomnia and PSG-measured short sleep duration (i.e., < 6 hours) on the risk for hypertension and T2D even after controlling for multiple confounders, including SDB(178-180).”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [179]

  • The odds of type-2 diabetes in individuals with insomnia who slept <6 hours were 2.1- to 3.0-fold cross-sectionally.

    “Specifically, the odds of T2D in individuals with insomnia who slept < 6 hours were 2.1- to 3.0-fold cross-sectionally”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [179]

  • The odds of hypertension in individuals with insomnia who slept <6 hours were 3.5- to 5.1-fold cross-sectionally and 3.8-fold longitudinally.

    “and the odds of hypertension were 3.5- to 5.1-fold cross-sectionally71 and 3.8-fold longitudinally”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [179]

  • These findings have been replicated in two recent studies in patients with insomnia using PSG-measured short sleep duration and MSLT-measured increased sleep latency.

    “Importantly, these findings have been replicated in two recent studies in patients with insomnia using PSG-measured short sleep duration(181) and MSLT-measured increased sleep latency(182).”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [181]

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1 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [20]20. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleepdisordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001;163:608-13.

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Authors
Bathgate, C. J., Edinger, J. D., Wyatt, J. K., & Krystal, A. D.
Affiliations
  • National Jewish Health (US)
  • Rush University Medical Center (US)
  • Duke Medical Center (US)
Corresponding author
Bathgate, Christina J.
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2016-05-01
Volume
39
Issue
5
Pages
1037-1045
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep.5748
PMC
PMC4835301
OpenAlex
W2343516606
Cited by
167
References
48
Citations by year
2026: 7 · 2025: 12 · 2024: 11 · 2023: 21 · 2022: 21 · 2021: 15 · 2020: 15 · 2019: 22 · 2018: 20 · 2017: 13 · 2016: 10
FWCI
30.76
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Mental Health (R01MH067057)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
insomnia, hypertension, short sleep duration, total sleep time, objective sleep measurement, sleep diary, polysomnography, comorbidities, hypertension risk prediction
MeSH terms
Adult, Cross-Sectional Studies, Disease Susceptibility, Female, Humans, Hypertension, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, ROC Curve, Sleep, Time Factors, Comorbidity, Prevalence, Logistic Models, Odds Ratio, Polysomnography, Self Report

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