Document Type : Original Article(s)

Authors

1 Associate Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: Hypertension (HTN) is an important risk factor for atherosclerotic and non-atherosclerotic cardiovascular disease (CVD). HTN increases risk of stroke and diabetes complications and at the end stage renal disease. Sleep disorders including short sleep duration are involved in pathogenesis of HTN. This study aimed to examine the association between self-reported sleep duration and HTN in a group of adult population in Isfahan City, Iran.METHODS: This cross-sectional survey was performed as part of the Isfahan Healthy Heart Program (IHHP). A total of 12492 individuals aged over 19 years (6110 men and 6382 women) entered the study. Sleep duration was recorded according to subjects’ self-report. HTN was defined as a systolic blood pressure (SBP) of ≥ 140 mmHg, a diastolic blood pressure (DBP) of ≥ 90 mmHg, or use of antihypertensive medication. The relation between sleep hours and HTN was examined using multiple logistic regression in three models, unadjusted, adjusted according to age and sex, and adjusted according to age, sex, body mass index (BMI), and waist circumference (WC).RESULTS: Sleeping time less than 5 hours, in comparison to sleep duration of 7-8 hours per night,was associated with a higher risk of HTN [odds ratio (OR) = 2.52, 95% confidence interval (CI): 2.17-2.93]. This association remained significant even after adjustment for age, sex, BMI, and WC (OR = 1.38, 95% CI: 1.16-1.64). Sleep duration over 9 hours had a negative association with risk of HTN among those under 60 years old (OR = 0.63, 95% CI: 0.47-0.86).CONCLUSION: Sleep duration less than 5 hours is positively associated with HTN. It seems that sleep duration might affect HTN and atherosclerotic CVD.

Keywords

  1. Najafian J, Mohamadifard N, Siadat ZD, Sadri G, Rahmati MR. Association between sleep duration and diabetes mellitus: Isfahan Healthy Heart Program. Niger J Clin Pract 2013; 16(1): 59-62.
  2. Najafian J, Toghianifar N, Mohammadifard N, Nouri F. Association between sleep duration and metabolic syndrome in a population-based study: Isfahan Healthy Heart Program. J Res Med Sci 2011; 16(6): 801-6.
  3. Bayon V, Laaban JP, Leger D. Metabolic and cardiovascular comorbidities and sleep disorders. Rev Prat 2007; 57(14): 1565-8.
  4. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, et al. Short sleep duration as a risk factor for hypertension: Analyses of the first National Health and Nutrition Examination Survey. Hypertension 2006; 47(5): 833-9.
  5. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of usual sleep duration with hypertension: The Sleep Heart Health Study. Sleep 2006; 29(8): 1009-14.
  6. Esteghamati A, Abbasi M, Alikhani S, Gouya MM, Delavari A, Shishehbor MH, et al. Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran. Am J Hypertens 2008; 21(6): 620-6.
  7. Sarrafzadegan N, Kelishadi R, Sadri G, Malekafzali H, Pourmoghaddas M, Heidari K, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: The Isfahan Healthy Heart Program. Arch Iran Med 2013; 16(1): 4-11.
  8. Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, et al. Isfahan Healthy Heart Programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
  9. Whelton PK, Williams B. The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines: More Similar Than Different. JAMA 2018; 320(17): 1749-50.
  10. Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009; 32(4): 491-7.
  11. Cappuccio FP, Stranges S, Kandala NB, Miller MA, Taggart FM, Kumari M, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: The Whitehall II Study. Hypertension 2007; 50(4): 693-700.
  12. Lopez-Garcia E, Faubel R, Guallar-Castillon P, Leon-Munoz L, Banegas JR, Rodriguez-Artalejo F. Self-reported sleep duration and hypertension in older Spanish adults. J Am Geriatr Soc 2009; 57(4): 663-8.
  13. van den Berg JF, Tulen JH, Neven AK, Hofman A, Miedema HM, Witteman JC, et al. Sleep duration and hypertension are not associated in the elderly. Hypertension 2007; 50(3): 585-9.
  14. Meng L, Zheng Y, Hui R. The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of prospective cohort studies. Hypertens Res 2013; 36(11): 985-95.
  15. Gangwisch JE, Feskanich D, Malaspina D, Shen S, Forman JP. Sleep duration and risk for hypertension in women: Results from the nurses' health study. Am J Hypertens 2013; 26(7): 903-11.
  16. Campi TW, Carpenter TE, Hird DW, Snipes KP, Hirsh DC. Fowl cholera in California multiplier breeder turkeys: 1985-86. Avian Dis 1990; 34(4): 928-33.
  17. Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: Effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev 2008; 12(3): 197-210.
  18. Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, et al. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985 ) 2005; 98(6): 2024-32.
  19. Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, et al. A prospective study of change in sleep duration: Associations with mortality in the Whitehall II cohort. Sleep 2007; 30(12): 1659-66.
  20. Eguchi K, Pickering TG, Schwartz JE, Hoshide S, Ishikawa J, Ishikawa S, et al. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med 2008; 168(20): 2225-31.
  21. Li H, Ma XQ, Ye F, Zhang J, Zhou X, Wang ZH, et al. Expressions of cardiac sympathetic norepinephrine transporter and beta1-adrenergic receptor decreased in aged rats. J Zhejiang Univ Sci B 2009; 10(3): 203-10.
  22. Gangwisch JE. A review of evidence for the link between sleep duration and hypertension. Am J Hypertens 2014; 27(10): 1235-42.