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Kazuo Eguchi, MD, PhD; Thomas G. Pickering, MD, DPhil; Joseph E. Schwartz, PhD; Satoshi Hoshide, MD; Joji Ishikawa, MD; Shizukiyo Ishikawa, MD, PhD; Kazuyuki Shimada, MD, PhD; Kazuomi Kario, MD, PhD

Arch Intern Med. 2008;168(20):2225-2231.

Background  It is not known whether short duration of sleep is a predictor of future cardiovascular events in patients with hypertension.

Methods  To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD), we performed ambulatory blood pressure (BP) monitoring in 1255 subjects with hypertension (mean [SD] age, 70.4 [9.9] years) and followed them for a mean period of 50 (23) months. Short sleep duration was defined as less than 7.5 hours (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio and 95% confidence interval (CI) for short sleep duration. A riser pattern was defined when mean nighttime systolic BP exceeded daytime systolic BP. The end point was a cardiovascular event: stroke, fatal or nonfatal myocardial infarction (MI), and sudden cardiac death.

Results  In multivariable analyses, short duration of sleep (<7.5 hours) was associated with incident CVD (hazard ratio [HR], 1.68; 95% CI, 1.06-2.66; P = .03). A synergistic interaction was observed between short sleep duration and the riser pattern (P = .09). When subjects were classified according to their sleep time and a riser vs nonriser pattern, the group with shorter sleep duration plus the riser pattern had a substantially and significantly higher incidence of CVD than the group with predominant normal sleep duration plus the nonriser pattern (HR, 4.43; 95% CI, 2.09-9.39; P < .001), independent of covariates.

Conclusions  Short duration of sleep is associated with incident CVD risk and the combination of the riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of patients with hypertension.

Author Affiliations: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan (Drs Eguchi, Hoshide, J. Ishikawa, S. Ishikawa, Shimada, and Kario); Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Medical Center, New York, New York (Drs Eguchi and Pickering); and Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York (Dr Schwartz).

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