A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study

Abstract

Background: Poor sleep is associated with increased hypertension risk, but few studies have evaluated multiple sleep dimensions or investigated racial/ethnic disparities in this association among women. Method: We investigated multiple sleep dimensions (sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping and difficulty falling or staying asleep) and hypertension risk among women, and determined modification by age, race/ethnicity and menopausal status. We used data from the Sister Study, a national cohort of 50 884 women who had sisters diagnosed with breast cancer in the United States enrolled in 2003–2009 and followed through September 2018. Results: Of 33 497 women without diagnosed hypertension at baseline (mean age ± standard deviation: 53.9 ± 8.8 years; 88.7% White, 6.4% Black and 4.9% Hispanic/Latina), 23% (n = 7686) developed hypertension over a median follow-up of 10.1 years [interquartile range: 8.2–11.9 years]. Very short, short or long sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping, insomnia, insomnia symptoms as well as short sleep and exploratory cumulative poor sleep score were associated with incident hypertension after adjustment for demographics factors. After additional adjustment for lifestyle and clinical factors, insomnia [hazard ratio = 1.09, 95% confidence interval (95% CI): 1.03–1.15] and insomnia symptoms plus short sleep (hazard ratio = 1.13, 95% CI: 1.05–1.21) remained associated with incident hypertension. These associations were stronger in younger (age<54 vs. ≥54 years) and premenopausal vs. postmenopausal women (all P-interaction < 0.05). Associations did not differ by race/ethnicity (all P-interaction > 0.05). Conclusion: Thus, screening for multiple sleep dimensions and prioritizing younger and premenopausal women may help identify individuals at high risk for hypertension.

Association of Nap Frequency With Hypertension or Ischemic Stroke Supported by Prospective Cohort Data and Mendelian Randomization in Predominantly Middle-Aged European Subjects

“…(2) Ethnic differences and sex differences: 2 studies found that daytime napping was protective in China, and a protective cardiovascular effect of estrogen may exist in women to prevent incident hypertension. 6 (3) Differences in the measurement of napping behavior and confounder adjustment: the classification of nappers and nonnappers varied, and sleep-related confounders, such as night sleep duration and sleep apnea, were not taken into account in many articles, which would cause varied estimates of odds ratio.…”

“…Previous studies on the relationship between daytime napping and hypertension have focused on cross-sectional studies, lacked a prospective study design (except for one prospective study in 2021 6 ), and reported conflicting conclusions. 7–12 For example, some studies 7,8,10,12 found that daytime napping poses a higher risk of hypertension, but 2 Chinese cohorts 9,11 found that daytime napping may be protective against hypertension, while other studies found no association between daytime napping and hypertension.…”

“…[7][8][9][10][11][12] For example, some studies 7,8,10,12 found that daytime napping poses a higher risk of hypertension, but 2 Chinese cohorts 9,11 found that daytime napping may be protective against hypertension, while other studies found no association between daytime napping and hypertension. 6 The relationship of daytime napping with stroke is also controversial. 3 Additionally, Mendelian randomization (MR), using lead single-nucleotide polymorphisms (SNPs) identified in genome-wide association studies (GWAS) as genetic instruments, can overcome unmeasured confounds that limit observational studies and validate causality.…”

“…7–12 For example, some studies 7,8,10,12 found that daytime napping poses a higher risk of hypertension, but 2 Chinese cohorts 9,11 found that daytime napping may be protective against hypertension, while other studies found no association between daytime napping and hypertension. 6 The relationship of daytime napping with stroke is also controversial. 3…”

Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

“…[3][4][5][6][7][8][9] Psychosocial stress related to experiencing discrimination can activate biologic stress response pathways as well as contribute to maladaptive health behaviors (eg, suboptimal diet) that are risk factors for hypertension. [10][11][12] Chronic discrimination may also contribute to long-term physiological wear and tear or increased allostatic load and, for instance, arousal during sleep periods-another risk factor for hypertension. 11,[13][14][15] Associations between experiencing racial and ethnic discrimination (RED) and hypertension likely vary by educational attainment within racial and ethnic groups.…”