Daytime Sleep as Compensation for the Effects of Reduced Nocturnal Sleep on the Incidence of Hypertension: A Cohort Study

Abstract

The role of sleep duration in the development of hypertension remains controversial. Little is known about the combined effects of nocturnal and daytime sleep. We assessed the association between total sleep duration and the development of hypertension in middle-aged and elderly Chinese adults. Patients and Methods: Data were obtained from 3 waves of China Health and Retirement Longitudinal Study surveys. Middle-aged and elderly Chinese initially without hypertension were followed biennially from 2011 to 2015. Sleep duration was self-reported. Hypertension was defined as a systolic and/or diastolic blood pressure ≥ 140/90 (mmHg), the current use of anti-hypertensive medications or self-reported hypertension. Results: Over 31,392 person-years of follow-up, 2682 of 10,176 participants developed hypertension. The multivariable adjusted hazard ratios (HR) (95% confidence intervals, 95% CI) for the development of hypertension between those with 0-30 minutes and ≥30 minutes daytime sleep vs those without daytime sleep were 0.67 (0.58, 0.77), and 0.73 (0.59, 0.92), respectively. The protective role of longer periods of daytime sleep (>30 minutes) varied between different subgroups. Compared with moderate nocturnal sleepers, long nocturnal sleepers (HR: 1.66, 95% CI=1.25-2.21) had an increased risk of hypertension. Compared with moderate nocturnal sleepers without daytime sleep, HRs (95% CI) for hypertension were 0.52 (0.45, 0.59) for short nocturnal sleep plus short daytime sleep and 0.55 (0.49, 0.62) for short nocturnal sleep plus long daytime sleep. People with extremely short (HR: 1.34, 95% CI=1.22-1.48) and long (HR: 1.28, 95% CI=1.13-1.44) combined sleep periods had an increased risk of hypertension. Consistent results were also found in subgroups stratified by age and gender. Conclusion: Both extremely long and short total sleep periods were associated with an increased risk of hypertension. People with short or moderate nocturnal sleep durations, especially short nocturnal sleep duration, can benefit from habitual daytime sleep to prevent hypertension.

Association between Sleep Duration and Hypertension among Adults in Southwest China

“…Our study concluded that insufficient sleep was associated with an increased risk of hypertension, which was consistent with the results of most previous studies [1,2,3,6,7,8,[12][13][14][15]. However, our results demonstrated that participants with only a short (<6 h/day) sleep duration had a greater risk of hypertension, while a long (>8 h/day) sleep duration did not significantly increase the risk of hypertension.…”

“…However, there have been clear discrepancies among the findings of these studies. Certain studies found that both short and long sleep durations were associated with an increased risk of hypertension [1,2,13,14], while several studies only identified a short sleep duration as associated with an increased risk of hypertension [3,6,7,8,12,15], and yet other studies denied this association [5,11,17]. The objective of the current study was to evaluate the association between self-reported sleep duration and hypertension among adults in southwest China.…”

Association between sleep duration and hypertension incidence: Systematic review and meta-analysis of cohort studies

“…Heterogeneity was measured using I 2 statistics [ 22 ]. We conducted a sub-group analysis to evaluate the relationship between sleep duration and risk of HTN incidence after stratification according to the different definitions of short (< 5 hours, 5 to 7 hours) [ 23 – 25 ] and long (8 to 9 hours, and > 9 hours) [ 23 , 24 , 26 ] sleep durations and different durations of follow-up (< 5 years and >5 years), in instances where I 2 surpassed 50%. Potential publication bias was evaluated via funnel plot asymmetry, Egger’s regression, and the Begg tests [ 27 ].…”

Influências dos transtornos de sono-vigília sobre a saúde cardiovascular na Atenção Primária à Saúde

“…Acredita-se que a curta duração do sono noturno ou a sua baixa qualidade foi compensada pelo sono diurno, o que pode ter atenuado os resultados adversos à saúde. Essa interpretação foi corroborada em outra investigação, que destaca, ainda, que o sono diurno habitual pode reduzir o risco de incidência de HAS de forma independente, conforme resultados de um estudo de coorte (27) . Destarte, o ritmo circadiano, como relógio fisiológico, é um biomarcador natural da relação entre vigília e repouso, sendo que o natural é a ocorrência de uma vigília diurna e de um repouso noturno, com duração aproximada de oito horas/noite.…”

“…Sendo assim, a compensação diurna do sono pode, portanto, desempenhar um importante papel na prevenção da HAS em adultos e idosos que conseguem dormir por curtos períodos durante a noite. Nesse sentido, o "cochilo" diurno pode melhorar o estresse neuroendócrino e a recuperação imunológica, com potencial efeito profilático na saúde cardiovascular em longo prazo (27)(28) .…”