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Association Between Sleep and Blood Pressure in MidlifeThe CARDIA Sleep Study
Kristen L. Knutson, PhD;
Eve Van Cauter, PhD;
Paul J. Rathouz, PhD;
Lijing L. Yan, PhD;
Stephen B. Hulley, MD, MPH;
Kiang Liu, PhD;
Diane S. Lauderdale, PhD
Arch Intern Med. 2009;169(11):1055-1061.
Background Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.
Methods This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.
Results After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex, shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05). Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78). Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP. Sleep duration appeared to mediate the difference between African Americans and whites in DBP change over time (P = .02).
Conclusion Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.
Author Affiliations: Departments of Health Studies (Drs Knutson, Rathouz, and Lauderdale) and Medicine (Dr Van Cauter), University of Chicago, and Department of Preventive Medicine, Northwestern University (Drs Yan and Liu), Chicago, Illinois; Department of Applied Economics, Guanghua School of Management, Peking University, Beijing, China (Dr Yan); and Department of Epidemiology and Biostatistics, University of California at San Francisco (Dr Hulley).
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