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June 12, 2009 — More evidence that a good night's sleep is associated with better control of blood pressure has come from a new study [1].
The study, published in the June 8, 2009, issue of the Archives of Internal Medicine, was conducted by a group led by Dr Kristen Knutson (University of Chicago, IL).
Knutson explained to heartwire that previous studies have suggested a link between poor sleep and increased blood pressure but that these have had limitations. "They have generally been short-term laboratory tests, but we wanted to look at the real-life situation and study the effects of habitual sleep patterns. In addition, previous studies that have tried to address longer-term sleep issues have relied on self-reporting of sleep quality, but we measured actual sleep duration and quality using a specifically designed wrist band," she said.
The band, known as an Actiwatch-16 (Philips Respironics, Murrysville, PA) wrist-activity monitor, contains sensors that count wrist movements in 30-second time periods, which determine whether the subject is asleep or awake, and has been validated against polysomnography as a good measure of sleep duration and quality, Knutson commented.
"We found that short sleepers had a larger increase in blood pressure over five years than those who slept longer," Knutson said. "Evidence suggests that a certain amount of sleep is necessary for many different functions in the body, including immune function and glucose metabolism, and if we can extend sleep in those who don't sleep well or for long enough, this should translate into many health benefits--one of which may well be lower blood pressure," she added.
Knutson said it was important to acknowledge the need to spend a certain amount of time asleep. "Five or six hours a night is not enough. Seven hours should really be the minimum. In the US, we have a work culture that discourages decent sleeping patterns. There seems to be a sort of badge of honor associated with sleeping only a few hours each night, and someone who sleeps for seven to eight hours may be perceived as not being hard-working enough. We need to change that culture."
She also believes that those individuals who appear to need only three or four hours of sleep each night may be fooling themselves. "People who sleep for short times do not do well in performance tests, even if they think they are well rested. Even these people should try to increase their sleep times," she said.
The current sleep study was ancillary to the large ongoing cohort CARDIA study, which is examining coronary risk in young adults. For the sleep study, 578 early-middle-aged adults participating in the CARDIA study had their blood pressure measured in 2000 and 2001 and in 2005 and 2006 and underwent sleep assessments using wrist actigraphy on two occasions for three consecutive days between 2003 and 2005.
Results showed that after the exclusion of patients who were taking antihypertensive medications, shorter sleep duration and lower sleep quality predicted significantly higher systolic and diastolic blood pressure at baseline as well as more adverse changes in blood-pressure levels over five years.
Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio 1.37; 95% CI 1.05–1.78). Each hour of reduction in sleep duration was associated with a 37% increase in the odds of incident hypertension.
Might Explain Higher Blood Pressure in Men and African Americans
Consistent with other studies, the current results show higher blood pressure in men, particularly African American men, who also slept much less than white women. "These two observations suggest the intriguing possibility that the well-documented higher blood pressure in African Americans and men might be partly related to sleep duration," the researchers write.
The authors note that laboratory studies of short-term sleep deprivation have suggested potential mechanisms for a causal link between sleep loss and hypertension: it is thought that sleep loss may lead to increased sympathetic nervous activity, which could cause high blood pressure if sleep loss were chronic.
They point out that, to their knowledge, the present study is the first to obtain objective measures of sleep duration and quality in a large sample of adults and to reveal associations between poor sleep quality and adverse effect on blood-pressure regulation and risk of hypertension in early-middle-aged adults.
"Because of the major adverse health consequences of high blood pressure, the identification of a new and potentially modifiable risk factor has clinical implications," the authors conclude. "The next step would be intervention studies to try to extend or improve sleep in hypertensive patients and see if we can improve their blood-pressure profile. Such a study is in the works," Knutson told heartwire .
Reference
Self-reported short sleep duration and high blood pressure have been linked in epidemiologic studies. However, most of these studies were cross-sectional and relied on self-report of usual sleep duration vs objective measures, and the potential role of sleep quality independent of sleep duration has not been studied in adults.
Potential mechanisms for a causal link between sleep loss and hypertension include increased sympathetic activity. If sleep duration is, in fact, a lifestyle risk factor for high blood pressure, new interventions might be developed to prevent hypertension or reduce high blood pressure.
Middle-aged adults who sleep fewer hours appear more likely to have high blood pressure and to experience adverse changes in blood pressure with time.
