Sleep Duration and Hypertension: Epidemiological Evidence and Underlying Mechanisms

Sleep and Cardiovascular Health

Sleep is recognized as a foundational pillar of health, essential for maintaining nearly all vital processes, and a crucial component of cardiovascular function. In recent years, there has been a paradigm shift to conceptualize sleep health as a combination of multiple domains, including duration, timing, quality, variability/regularity, habits/behaviors, and disordered sleep. This review provides a comprehensive overview of the current evidence linking the multifaceted elements that contribute to healthy sleep with cardiovascular and blood pressure-related outcomes. The reviewed literature indicates a strong relationship between sleep and cardiovascular health. However, the specific pathophysiological mechanisms that bridge the various dimensions of sleep with cardiovascular outcomes remain elusive. Given the global burden of cardiovascular disease, understanding the interplay between sleep and cardiovascular health has important implications for both individual and population health. Sustained efforts to move beyond a focus on discrete domains of sleep are essential to fully understand this complex and potentially bidirectional relationship. Promoting healthy sleep patterns and optimizing the management and treatment of sleep disorders are key steps toward developing more comprehensive strategies for reducing cardiovascular risk. Integrating sleep health into routine clinical care is identified as a critical opportunity to enhance cardiovascular disease prevention and management, particularly among vulnerable and high-risk populations.

A large-scale genome-wide study of gene-sleep duration interactions for blood pressure in 811,405 individuals from diverse populations

Although both short and long sleep duration are associated with elevated hypertension risk, our understanding of their interplay with biological pathways governing blood pressure remains limited. To address this, we carried out genome-wide cross-population gene-by-short-sleep and long-sleep duration interaction analyses for three blood pressure traits (systolic, diastolic, and pulse pressure) in 811,405 individuals from diverse population groups. We discovered 22 novel gene-sleep duration interaction loci for blood pressure, mapped to 23 genes. Investigating these genes' functional implications shed light on neurological, thyroidal, bone metabolism, and hematopoietic pathways that necessitate future investigation for blood pressure management that caters to sleep health lifestyle. Non-overlap between short sleep (12) and long sleep (10) interactions underscores the plausible nature of distinct influences of both sleep duration extremes in cardiovascular health. Several of our loci are specific towards a particular population background or sex, emphasizing the importance of addressing heterogeneity entangled in gene-environment interactions, when considering precision medicine design approaches for blood pressure management.

Impact of insomnia: Cultural and societal aspects from a European survey

OBJECTIVES

This European study explored the cultural and societal aspects of chronic insomnia by means of a survey undertaken in France, Germany, Italy, Spain, and the United Kingdom. The primary objectives were to understand the impact of insomnia on the daily lives of patients, both personally and professionally, and to evaluate the patients' perceptions and coping strategies thus identifying cultural differences in the management of this disorder.

METHODS

Based on online panels targeting insomnia sufferers, the survey included 755 patients aged 35 to 65 years with moderate to severe insomnia for at least three months, occurring at least three times per week (DSM-5 criteria for insomnia disorder, ISI score 15-28). Topics covered included the impact of insomnia on daily life, strategies for coping and managing insomnia, and patients' perceptions and views of insomnia.

RESULTS

A total of 755 patients completed the questionnaire. Most respondents were women (70%) and between 35 and 49 years of age (50%). About half of the patients (49%) had severe insomnia, with 49% experiencing it for over three years. Nearly 70% did not initially consider their insomnia serious, and 73% believed their condition would improve over time. Stress (39%), difficulty relaxing in the evening (37%), and a rapid flow of thoughts (37%) were identified as the main causes of insomnia. Insomnia was shown to significantly affect daily life, particularly work performance, relationships, and maintaining healthy habits. British patients were the most affected, with 85% reporting decreased work performance. In France, only 51% reported difficulties maintaining relationships. There were 77% of Britons who felt exposed to dangerous situations, such as drowsiness while driving (47%). Coping strategies varied by country but, overall, breathing exercises (43%), meditation (32%), and reducing caffeine intake (44%) were the most popular. Healthcare consultation approaches also varied. French patients consulted general practitioners (89%) but rarely specialists, while Germans consulted sleep specialists (20%) and psychiatrists (19%). Overall, 61% reported that doctors recommended lifestyle changes.

CONCLUSIONS

The survey highlights cultural differences in insomnia perception and management in Europe. Insomnia is often trivialized, thus delaying management. The results underline the need to raise awareness among patients and healthcare professionals of the importance of insomnia and its consequences on mental and physical health. Addressing chronic insomnia requires a multifaceted approach that includes cultural sensitivity, patient education, and proactive healthcare engagement. By understanding and integrating these elements, healthcare providers can better support patients to manage their condition, ultimately improving their quality of life.

Association between weekend catch-up sleep and hypertension of the United States population from 2017 to 2020: a cross-sectional study

Background

Hypertension is a prevalent cardiovascular risk factor that significantly contributes to morbidity and mortality worldwide. Previous studies have highlighted the role of inadequate sleep during weekdays in the development of hypertension. However, the potential mitigative effects of weekend catch-up sleep (WCS) on hypertension have been less explored.

Methods

This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, focusing on American adults. We assessed the association between WCS (defined as the difference in sleep duration between weekend and weekday) and the presence of hypertension. Participants were classified into two groups based on their WCS duration: none (below 1 hours), yes (over 1 hours). Multivariable logistic regression models adjusted for potential confounders such as age, gender, Body mass index (BMI), and lifestyle factors were utilized to explore this association. A Generalized Additive Model (GAM) was employed to generate smooth curves for a nuanced analysis of the nonlinear relationship.

Results

The findings indicated that moderate WCS (less than 4 hours) was significantly associated with a reduced risk of hypertension, while excessive WCS (greater than 4 hours) showed no significant protective benefits.

Conclusion

Moderate weekend catch-up sleep could serve as an effective intervention to mitigate hypertension risk, especially in populations with restricted weekday sleep. These results suggest the potential for integrating sleep management strategies into public health recommendations to address hypertension. Future longitudinal studies are needed to confirm these findings and clarify the mechanisms underlying the relationship between WCS and hypertension risk.

Sleep quality and hypertension in an indigenous African population: a cross-sectional investigation from the COMBAT-CVDs study

Hypertension is a major risk factor for cardiovascular events worldwide, and little is known about its association with sleep quality (SQ) among Africans. We evaluated the association of SQ with hypertension among adults in Ibadan, Nigeria. In Ibadan and its suburbs, we identified 3635 participants in the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases (COMBAT-CVDs) study. SQ was self-reported, and SQ scores were classified by the tertile distribution in this sample as good (<9), moderate (10-18), and poor (≥19), and hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or prior diagnosis by a certified health professional or current use of blood pressure-lowering drugs. Using good SQ as a reference, logistic regression models were used to estimate the multivariable-adjusted odds ratio and 95% confidence interval (CI) for odds of hypertension by tertiles of SQ scores in a two-sided test at p < 0.05. In all, 1182 (32.5%) had poor SQ, 903 (24.8%) had hypertension, and the mean(±SD) age was 35.3 ± 15.2 years in this sample. The multivariable-adjusted odds of hypertension by tertiles of SQ scores (using good SQ as reference) were OR: 1.13 (95% CI: 0.92, 1.38) for moderate SQ, and OR: 1.29 (95% CI: 1.05, 1.59) for poor SQ; P for trend = 0.06 after adjusting for relevant covariates. Poor SQ is associated with higher odds of hypertension in this sample. The imperative of culturally sensitive interventions to improve SQ would be promising in managing poor sleep-associated hypertension burden in this population.

Unveiling relationships of human instinctive behaviors and blood pressure in Chinese adults: A network analysis

OBJECTIVES

Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control.

STUDY DESIGN

Cohort study.

METHODS

This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP.

RESULTS

The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (β = -0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis.

CONCLUSIONS

Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, non-sedentary behaviors, and dietary behaviors to disrupt malignant cycles.

Association of the Korean Healthy Eating Index and sleep duration with prediabetes in middle-aged adults

BACKGROUND/OBJECTIVES

Sleep duration and diet quality are reportedly associated with the risk of diabetes. This study aimed to examine the risk of diabetes according to sleep duration and diet quality in middle-aged Koreans.

SUBJECTS/METHODS

Using the Korea National Health and Nutrition Examination Survey 2019-2020, raw data from 2,934 participants aged 40-64 yrs (1,090 men and 1,844 women) who were not diagnosed with type 2 diabetes were analyzed. With a sleep duration of 7-7.9 h per night as the referent category, diet quality was assessed using the Korean Healthy Eating Index (KHEI), which comprises adequacy, moderation, and energy balance.

RESULTS

The study results showed that individuals with a short sleep duration had significantly higher blood glucose (P = 0.034) and HbA1c levels (P < 0.001) than those had by individuals with a sleep duration of 7-7.9 h. Within the group with a sleep duration of 7-7.9 h, the lowest quintile of the KHEI score had a significantly higher risk of prediabetes than that had by the highest quintile of the KHEI score (Model 1: odds ratio [OR], 1.775; 95% confidence interval [CI], 1.072-2.939; P < 0.05 and Model 2: OR, 1.731; 95% CI, 1.040-2.882; P < 0.05).

CONCLUSION

Our findings suggest that achieving the sleep duration of 7-7.9 h and eating good diet are associated with the lowest risk of prediabetes. We recommend that the results of this study be used to educate adults aged 40-64 yrs on diet and lifestyle habits to prevent diabetes.

Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women

BACKGROUND

Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.

METHODS

A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the "Life's Essential 8" (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including "low LE8" (0-49), indicating low CVH, "moderate LE8 (50-79)", indicating moderate CVH, and "high LE8 (80-100)", indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.

RESULTS

Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46-0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001).

CONCLUSION

While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.

Association between joint physical activity and sleep duration and hypertension in US adults: Cross-sectional NHANES study

BACKGROUND

Previous studies have adequately demonstrated that physical activity or healthy sleep duration can reduce the risk of hypertension. However, the combined effects of physical activity and healthy sleep on hypertension have not been well explored in studies using nationally representative samples.

METHODS

The data were obtained from the National Health and Nutrition Examination Survey (2007-2018). Sleep duration and physical activity were obtained from self-reported questionnaires. Survey logistic regression and restricted cubic spline curves were used to evaluate the joint effects of physical activity and healthy sleep duration on hypertension.

RESULTS

A total of 18,007 participants were enrolled in the main study. Physical activity was categorized into insufficient physical activity (600 < Met-min/week) and sufficient physical activity (≥600 Met-min/week). Sleep duration of ≤6 or ≥9 hours was defined as unhealthy sleep duration, and 7-8 hours was defined as healthy sleep duration. Compared to the individuals with unhealthy sleep duration and insufficient physical activity, only the participants with healthy sleep duration and sufficient physical activity (adjusted odds ratio: 0.76, 95% CI 0.66-0.88) were negatively associated with hypertension, while the participants with healthy sleep duration but insufficient physical activity or sufficient physical activity but unhealthy sleep duration were not associated with hypertension. Physical activity was nonlinearly associated with hypertension in the healthy sleep duration group, whereas in the unhealthy sleep duration group, physical activity was not associated with hypertension.

CONCLUSION

Our findings indicate that sufficient physical activity and healthy sleep duration were negatively associated with hypertension. This underscores the importance of integrating both sufficient physical activity and healthy sleep duration in strategies aimed at reducing hypertension risk.

Short Sleep Duration and Hypertension: A Double Hit for the Brain

BACKGROUND

Short sleep duration has been associated with an increased risk of cognitive impairment and dementia. Short sleep is associated with elevated blood pressure, yet the combined insult of short sleep and hypertension on brain health remains unclear. We assessed whether the association of sleep duration with cognition and vascular brain injury was moderated by hypertensive status.

METHODS AND RESULTS

A total of 682 dementia-free participants (mean age, 62±9 years; 53% women) from the Framingham Heart Study completed assessments of cognition, office blood pressure, and self-reported habitual and polysomnography-derived sleep duration; 637 underwent brain magnetic resonance imaging. Linear regressions were performed to assess effect modification by hypertensive status on total sleep time (coded in hours) and cognitive and magnetic resonance imaging outcomes. There was a significant interaction between sleep duration and hypertensive status when predicting executive function/processing speed (Trail Making B-A) and white matter hyperintensities. When results were stratified by hypertensive status, longer sleep duration was associated with better executive functioning/processing speed scores in the hypertensive group (meaning that shorter sleep duration was associated with poorer executive function/processing speed scores) (self-report sleep: β=0.041 [95% CI, 0.012-0.069], P=0.005; polysomnography sleep: β=0.045 [95% CI, 0.002-0.087], P=0.038), but no association was observed for the normotensive group. Similarly, shorter subjective sleep duration was associated with higher white matter hyperintensity burden in the hypertensive group (β=-0.115 [95% CI, -0.227 to -0.004], P=0.042), but not in the normotensive group.

CONCLUSIONS

In individuals with hypertension, shorter sleep duration was associated with worse cognitive performance and greater brain injury.

Inter-Individual Responses to Acute Resistance Training in the Blood Pressure Dipping Response in Normotensive and Hypertensive Men

The blood pressure dipping response to acute resistance training exercise (RTE) is scarce in the literature. We determined the inter-individual blood pressure (BP) dipping variability of normotensive (NT) and hypertensive (HT) men completing two modalities of a single session of RTE. Volunteers (NT n = 21, HT n = 20) underwent a non-exercise control (CTRL), RTE high-sets low-repetitions (HSLR), and RTE high-repetitions low-sets (HRLS) conditions. Twenty-four-hour ambulatory BP monitoring recorded diurnal and nocturnal systolic (SBP) and diastolic (DBP) BP. Non-significant interactions were found between the category of individuals and the experimental conditions on the SBP (p = 0.511, η2 p = 0.02) and DBP (p = 0.807, η2 p = 0.01) differences. Diurnal SBP (p = 0.0001) and DBP (p ≤ 0.0001) were lower in the NT than in the HT groups. Nocturnal SBP (p ≤ 0.0001) and DBP (p = 0.014) were lower in the NT than in the HT groups. The percentage of dipping responders for SBP in the CTRL condition were 71.4% for NT and 70.0% for HT, in the HRLS condition were 66.7% for NT and 60.0% for HT, and in the HSLR condition were 57.1% for NT and 60.0% for HT. The dipping responders for DBP in the CTRL condition were 57.1% for NT and 60.0% for HT, in the HRLS condition were 61.9% for NT and 70.0% for HT, and in the HSLR condition were 71.4% for NT and 65.0% for HT (p > 0.05 for all). In conclusion, the dipping response was similar between NT and HT individuals. The proportion of responders was similar between NT and HT individuals completing acute RTE.

Sleep Health Patterns in Romania: Insights from a Nationwide Cross-Sectional Online Survey

BACKGROUND

Sleep is one of the most essential processes for sustaining cognitive, emotional, and physical health across all age groups. Insomnia or inadequate sleep significantly impacts health and poses economic burdens due to increased healthcare costs and reduced productivity.

OBJECTIVES AND METHODS

This study aimed to investigate sleep quality in the Romanian active population using an online survey incorporating the Pittsburgh Sleep Quality Index (PSQI). Conducted over four months in 2023, the survey gathered 2243 complete responses from urban and rural residents over the age of 18.

RESULTS

The results highlight gender and urban-rural disparities in sleep quality, revealing that females and urban residents experienced poorer sleep compared to their counterparts. Additionally, sleep quality was found to significantly worsen with age, with elders (56+ years) reporting the highest PSQI scores, indicating greater sleep difficulties compared to middle-aged adults and youngsters. A high prevalence of sleep disturbances, daytime dysfunctions, and sleep medication use was reported. Common pre-sleep activities included using electronic devices and watching TV, while fewer participants engaged in reading books or consuming alcohol and caffeine. Additionally, participants' bedding preferences were documented.

CONCLUSIONS

Our study highlights the influence of various factors on sleep quality and emphasizes the need for targeted public health interventions to improve sleep health in Romania.

Cardiovascular Implications of Sleep Disorders Beyond Sleep Apnea

PURPOSE OF REVIEW

Sleep is crucial for human health and life. There is still limited attention to the association between sleep disorders beyond sleep apnea and cardiovascular (CV) health. We investigated the current evidence between non-respiratory sleep disorders and CV health.

RECENT FINDINGS

Current evidence suggests an important association between sleep duration, circadian rhythm, insomnia, disorders of hypersomnolence and CV health. Sleep-related movement disorders exhibit a moderate association with CV health. Further research is needed to explore the effects of each sleep disorder on CV health.

SUMMARY

Given the close association between non-respiratory sleep disorders and CV health, it is crucial to recognize and address sleep disorders in patients with a high CV risk.

Assessing the Relationship Between Sleep Duration and the Prevalence of Chronic Kidney Disease Among Veterans in the United States: A 2022 Behavior Risk Factor Surveillance System (BRFSS) Cross-Sectional Study

INTRODUCTION

Chronic kidney disease (CKD) is more prevalent among veterans in the United States than in the general population. Similarly, veterans also exhibit higher rates of abnormal sleep duration compared to the general population. The aim of this study was to investigate the association between self-reported length of sleep and the prevalence of CKD among veterans in the United States using responses from the 2022 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

For this cross-sectional study, a total of 53,211 veterans who responded to the 2022 BRFSS survey were analyzed. Measures include the outcome variable which is self-reported CKD diagnosis and a major independent variable sleep duration. Sleep duration was recategorized into ≤ 5 hours (short sleep duration), 6-10 hours (normal sleep duration), and >10 hours (long sleep duration). Covariates included gender, age, race, residence, insurance, alcohol consumption, diabetes comorbidity, coronary artery disease (CAD) comorbidity, and stroke comorbidity. Descriptive, bivariate, and multivariate logistic regressions were conducted using the SAS software (SAS Institute Inc., Cary, North Carolina, United States).  Results: The prevalence of CKD among veterans in the United States is 3332 (6.29%). Veterans with sleep duration of 6-10 hours had 17.5% lower odds of CKD than veterans who slept for ≤5 hours (adjusted OR (AOR)= 0.825, 95%CI= 0.821-0.830; P=<0.0001). Veterans who slept for more than 10 hours had 68.2% higher odds of having CKD (AOR=1.682, 95%CI= 1.662-1.702; P=<0.0001). Additionally, veterans diagnosed with diabetes, stroke, and coronary artery disease had 2.447-2.103, and 2.838, respectively, higher odds of developing CKD (AOR=2.447, 95%CI= 2.435-2.459; p=<0.0001). Veterans who were 65 years and older had higher odds of developing CKD compared to those aged 35-44 years (AOR= 5.743, 95%CI= 5.669-5.818; P<0.001). The odds of having CKD were also higher among veterans who identified as Black (AOR 1.397, 95%CI =1.388-1.405; P<0.01) or as Hispanic (AOR =1.318, 95%CI = 1.307-1.329; P<0.01) compared to non-Hispanic White veterans. Those who identified as Asian had lower odds of CKD (AOR= 0.87, 95%CI=0.853-0.888; P<0.01). Furthermore, veterans who consumed alcohol had 7.8% lower odds of having CKD as compared to individuals who did not consume alcohol (AOR= 0.922, 95%CI =0.918-0.927; p=<0.0001). Male veterans had 24.7% lower odds of having CKD as compared to female veterans (AOR = 0.753, 95%CI= 0.747-0.758; P<0.001).  Conclusion: This research provides evidence of a greater prevalence of CKD among veterans with short sleep duration (≤ 5 hours) and long sleep duration (> 10 hours). Sleep hygiene education and sleep optimization programs can improve sleep and boost overall kidney health among veterans.

Association of a Healthy Lifestyle With Ambulatory 24-Hour Blood Pressure Among Chinese Youths: A Cross-Sectional Study

BACKGROUND

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths.

METHODS

A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing 5 lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into 3 categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mm Hg and/or diastolic BP (DBP) ≥ 80 mm Hg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg. We assessed the associations using the binomial regression model.

RESULTS

Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with a high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with a low level of adherence and after adjusting for the potential covariates.

CONCLUSIONS

A healthier lifestyle is associated with a better ambulatory BP profile among youths.

A Large-Scale Genome-Wide Study of Gene-Sleep Duration Interactions for Blood Pressure in 811,405 Individuals from Diverse Populations

Although both short and long sleep duration are associated with elevated hypertension risk, our understanding of their interplay with biological pathways governing blood pressure remains limited. To address this, we carried out genome-wide cross-population gene-by-short-sleep and long-sleep duration interaction analyses for three blood pressure traits (systolic, diastolic, and pulse pressure) in 811,405 individuals from diverse population groups. We discover 22 novel gene-sleep duration interaction loci for blood pressure, mapped to 23 genes. Investigating these genes' functional implications shed light on neurological, thyroidal, bone metabolism, and hematopoietic pathways that necessitate future investigation for blood pressure management that caters to sleep health lifestyle. Non-overlap between short sleep (12) and long sleep (10) interactions underscores the plausible nature of distinct influences of both sleep duration extremes in cardiovascular health. Several of our loci are specific towards a particular population background or sex, emphasizing the importance of addressing heterogeneity entangled in gene-environment interactions, when considering precision medicine design approaches for blood pressure management.

The Role of Gut Microbiome in Sleep Quality and Health: Dietary Strategies for Microbiota Support

Dietary components, including dietary fiber, unsaturated fatty acids, and polyphenols, along with meal timing and spacing, significantly affect the microbiota's capacity to produce various metabolites essential for quality sleep and overall health. This review explores the role of gut microbiota in regulating sleep through various metabolites such as short-chain fatty acids, tryptophan, serotonin, melatonin, and gamma-aminobutyric acid. A balanced diet rich in plant-based foods enhances the production of these sleep-regulating metabolites, potentially benefiting overall health. This review aims to investigate how dietary habits affect gut microbiota composition, the metabolites it produces, and the subsequent impact on sleep quality and related health conditions.

Association of Sleep Duration with Risk of All-Cause and Cause-Specific Mortality Among American Adults: A Population-Based Cohort Study

Objective

To examine potential factors affecting sleep duration and explore its association with the risk of mortality among adults in the United States.

Methods

The study population consisted of adults aged 26 to 79 years who participated in the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016. Sleep duration was classified into three categories: short (<7 hours), optimal (7-8 hours), and long (≥9 hours). The associations between sleep duration and both all-cause mortality and cause-specific mortality (including heart disease, tumors, cerebrovascular disease, and others) were examined in the overall population and subgroups using weighted Cox regression models. Dose-response associations between sleep duration and risk of all-cause mortality were explored using restricted cubic spline (RCS) analyses. Additionally, a multinomial logistic regression analysis was conducted to investigate potential factors that influence sleep duration in adults.

Results

The study included a total of 24,141 subjects, with a population-weighted mean age of 48.93 years. Over 30% of the subjects exhibited unhealthy sleep habits. Fully adjusted models revealed that both short sleep duration (HR=1.169, 95% CI 1.027-1.331) and long sleep duration (HR=1.286, 95% CI 1.08-1.531), were associated with an increased risk of all-cause mortality. The RCS curves showed a U-shaped relationship between sleep duration and risk of all-cause mortality. Subgroup analyses showed a significant association between poor sleep patterns and all-cause mortality among adults aged 26-64 years, males, and non-Hispanic whites. Furthermore, multinomial logistic regression identified several predictors associated with short and long sleep durations.

Conclusion

Both short and long sleep duration are associated with an increased risk of all-cause mortality, with a U-shaped dose-response relationship. It is imperative to implement appropriate primary prevention strategies aimed at monitoring and providing health education to populations at risk of developing unhealthy sleep patterns.

Dose-response relationship between sleep duration and cardiovascular metabolic multimorbidity among older adults in China: A nationwide survey

AIMS AND OBJECTIVES

The purpose of this study was to explore the relationship between the duration of sleep per day and cardiovascular metabolic multimorbidity (CMM) in older adults and to identify how many hours of sleep per day can lead to a lower risk of CMM in older adults.

BACKGROUND

CMM are a common syndrome in the older adults. There may be an association between sleep duration and CMM in older adults, with both insomnia and sleep deprivation having an impact on the health of older adults. Therefore, it is important to explore the possibility that older adults who sleep for a few hours per day may have a lower prevalence of CMM.

METHODS

The study included 9710 older adults. The sleep duration in this study was assessed by the question "How many hours of sleep do you currently get in a day? ". Older adults were defined as having CMM when they had two or more of the five categories of hypertension, diabetes, heart disease, stroke or cardiovascular disease, dyslipidemia. We used multivariate logistic regression analysis to explore the association among sleep duration and CMM. Restrictive cubic splines were used to examine the shape of the association among sleep duration and the CMM. The STROBE checklist was used for this cross-sectional study.

RESULTS

The mean age was 84.78 ± 11.73 years, with 55.5 % being female. Of the total sample, 21.3 % were CMM. When all covariates were adjusted, there was dose-response relationship between sleep duration and CMM. The dose-response relationship between CMM and sleep duration showed that older adults had a lower risk of cardiovascular and metabolic multimorbidity when they slept 9 h and 10 h per day.

CONCLUSION

With the increasing population of older adults, the number of older adults suffering from CMM continues to rise, and adequate sleep time can effectively prevent the occurrence of CMM. We should pay attention to the sleep problem of the older adults.

RELEVANCE TO CLINICAL PRACTICE

This study provided information for healthcare providers to identify circumstances that increase cardiovascular metabolic multimorbidity and suggest the appropriate sleep duration per day to reduce the risk of disease in older adults.

PATIENT OR PUBLIC CONTRIBUTION

Because of the public database data used in this study, all data were collected by survey agency personnel, so this section is not applicable to this study.

The Effect of Sleep Duration on Hypertension Risk in an Adult Asian Population: A Systematic Review and Meta-Analysis

Sleep duration has been proposed as a potential and important modifiable risk factor, yet its precise relationship with hypertension among Asian adults remains unclear. This meta-analysis aims to elucidate the impact of short sleep duration on hypertension risk within the adult Asian population. A systematic search of databases, including PubMed, Scopus, and ScienceDirect, was conducted to identify relevant studies published up to January 4, 2024. Eligible studies comprised observational cohort studies and cross-sectional studies that compared short sleep duration to normal sleep duration in relation to hypertension risk among Asian adults. The definitions for short and normal sleep durations were derived from the respective studies. The random effects model was utilized to pool effect estimates, and all statistical analyses were conducted using Review Manager 5.4 software (RevMan) (Cochrane Collaboration, Oxford, UK). Results from a systematic search obtained seven studies assessing sleep duration and hypertension risk in Asian populations. Based on a meta-analysis of six studies, short sleep duration is associated with a higher hypertension risk when compared to normal sleep duration (OR: 1.36; 95% CI: 1.13-1.64; p: 0.0010; I2: 75%). Subgroup analysis based on sex showed that the association is evident across males (OR: 1.12; 95% CI: 1.01-1.25; p: 0.03; I2: 64%) and females (OR: 1.22; 95% CI: 1.10-1.35; p: 0.0003; I2: 82%). In conclusion, based on the analyzed studies, short sleep duration is associated with a higher mild risk of hypertension, irrespective of sex. Thus, short sleep duration can be a modifiable risk factor that can be prevented to reduce the risk of hypertension. By incorporating sleep hygiene practices and promoting healthy sleep habits, significant improvement in cardiovascular health can be made, especially in hypertension risk at a population level. Further studies on the effect of sleep duration in different age populations should be conducted to confirm the impact of short sleep duration.

The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial

BACKGROUND

Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications.

OBJECTIVE

This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)-based lifestyle coaching program on achieving BP control among adults with hypertension.

METHODS

Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches.

RESULTS

In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI -7.1 to -4.2; P<.001) and 3.8 mm Hg (95% CI -4.7 to -2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI -12.2 to -6.9; P<.001) and 5.7 mm Hg (95% CI -7.6 to -3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI -10.1 to -6.1; P<.001) and 5.1 mm Hg (95% CI -6.2 to -3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI -17.7 to -10.7; P<.001) and 8.1 mm Hg (95% CI -10.4 to -5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks.

CONCLUSIONS

The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734.

Association between sleep pattern and incidence of hypertension: A prospective cohort study of older adult participants in the Chinese longitudinal healthy longevity survey

BACKGROUND

The relationship between sleep duration or sleep quality and the risk of hypertension has been previously examined. However, little is known regarding the association between sleep duration and quality and the risk of developing hypertension in the older adult Chinese population.

METHODS

The sleep patterns of 5683 participants without hypertension at baseline from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Cox proportional hazard models were used to study the associations between sleep patterns and hypertension.

RESULTS

It was found that 1712 (30.12%) of the 5683 participants had an unhealthy sleep pattern. After an average follow-up of 3.31 years, 1350 of the participants had hypertension. Compared with participants with an unhealthy sleep pattern, those with a healthy sleep pattern had a 20% (hazard ratio = 0.80, 95% confidence interval = 0.67-0.94, P = = 0.008) lower risk of incident hypertension in the fully adjusted models. In addition, an approximately linear dose-response association was observed between sleep duration and the incidence of hypertension (P for non-linear =0.43). Subgroup analyses demonstrated significant interactions between age and sleep pattern concerning hypertension (P for interaction <0.05). Several sensitivity analyses were conducted, and the obtained findings were similar to the main results.

CONCLUSIONS

A healthy sleep pattern, comprising an adequate sleep duration and good sleep quality, can help reduce hypertension risk. Thus, a healthy sleep pattern is crucial to decreasing hypertension in older Chinese adults in a rapidly aging society.

Microbiota Metabolite Profiles and Dietary Intake in Older Individuals with Insomnia of Short vs. Normal Sleep Duration

Recent evidence suggests that the gut microbiota plays a role in insomnia pathogenesis. This study compared the dietary habits and microbiota metabolites of older adults with insomnia of short vs. normal sleep duration (ISSD and INSD, respectively). Data collection included sleep assessment through actigraphy, dietary analysis using the Food Frequency Questionnaire, and metabolomic profiling of stool samples. The results show that ISSD individuals had higher body mass index and a greater prevalence of hypertension. Significant dietary differences were observed, with the normal sleep group consuming more kilocalories per day and specific aromatic amino acids (AAAs) phenylalanine and tyrosine and branch-chain amino acid (BCAA) valine per protein content than the short sleep group. Moreover, metabolomic analysis identified elevated levels of the eight microbiota metabolites, benzophenone, pyrogallol, 5-aminopental, butyl acrylate, kojic acid, deoxycholic acid (DCA), trans-anethole, and 5-carboxyvanillic acid, in the short compared to the normal sleep group. The study contributes to the understanding of the potential role of dietary and microbial factors in insomnia, particularly in the context of sleep duration, and opens avenues for targeted dietary interventions and gut microbiota modulation as potential therapeutic approaches for treating insomnia.

Association between sleep quality and blood pressure control among hypertensive patients at a rural tertiary hospital in Southern Nigeria: a cross-sectional study

OBJECTIVES

Restorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between sleep quality and blood pressure control among hypertensive patients in Southern Nigeria.

DESIGN

Cross-sectional study.

SETTING

A rural tertiary hospital in Southern Nigeria, April to June 2023.

PARTICIPANTS

250 systematically selected hypertensive adults. Participants completed a validated semistructured interviewer-administered questionnaire to assess their sleep patterns, including sleep duration, self-reported trouble sleeping and a history of clinical diagnosis of sleep disorders. Sleep patterns were categorised as restorative (healthy) or non-restorative (unhealthy). The blood pressure of respondents was checked and categorised as controlled (<140/90 mm Hg) or uncontrolled (≥140/90 mm Hg). Data were analysed descriptively using SPSS V.24.0 OUTCOME MEASURES: Quality of sleep and blood pressure control.

RESULTS

Respondents had a mean age of 51.5±10.0 years, with the majority being female (156, 62.4%), married (135, 54.0%) and belonging to the Esan tribe (125, 50.0%). The prevalence of restorative sleep was 36%, while the blood pressure control rate was 23.6%. An association was found between restorative sleep and blood pressure control (adjusted OR =4.38; 95% CI=2.37-8.10; p<0.0001). Respondents aged ≥60 years had 3.5 times higher odds of experiencing non-restorative sleep than those aged ≤40 years (aOR=3.46; 95% CI=1.37-8.74; p=0.009).

CONCLUSION

The study found an association between poor quality sleep and poor blood pressure control. Incorporating sleep assessments and interventions into comprehensive hypertension management strategies could be explored as a possible approach to improve sleep quality and enhance blood pressure control.

TRIAL REGISTRATION NUMBER

PACTR202301917477205.

A Large-Scale Genome-Wide Study of Gene-Sleep Duration Interactions for Blood Pressure in 811,405 Individuals from Diverse Populations

Although both short and long sleep duration are associated with elevated hypertension risk, our understanding of their interplay with biological pathways governing blood pressure remains limited. To address this, we carried out genome-wide cross-population gene-by-short-sleep and long-sleep duration interaction analyses for three blood pressure traits (systolic, diastolic, and pulse pressure) in 811,405 individuals from diverse population groups. We discover 22 novel gene-sleep duration interaction loci for blood pressure, mapped to genes involved in neurological, thyroidal, bone metabolism, and hematopoietic pathways. Non-overlap between short sleep (12) and long sleep (10) interactions underscores the plausibility of distinct influences of both sleep duration extremes in cardiovascular health. With several of our loci reflecting specificity towards population background or sex, our discovery sheds light on the importance of embracing granularity when addressing heterogeneity entangled in gene-environment interactions, and in therapeutic design approaches for blood pressure management.

Bidirectional associations between sleep quality/duration and multimorbidity in middle-aged and older people Chinese adults: a longitudinal study

BACKGROUND

Multimorbidity and sleep disorder possess high incidence rates in the middle-aged and older people populations, posing a significant threat to quality of life and physical and mental health. However, investigators have previously only analysed the unidirectional association between sleep status and multimorbidity. We aimed to investigate bidirectional associations between sleep quality or duration and multimorbidity in middle-aged and older Chinese adults from a longitudinal perspective.

METHOD

We enrolled a total of 9823 participants 45 years and older from the China Health and Retirement Longitudinal Study from 2015 to 2018 in our study. Multimorbidity was defined as two or more coexisting chronic diseases in the same individual based on 14 self-reported disease questions. Sleep quality was classified as "good" (restless < 1 day per week) and "poor" (restless ≥ 1 days per week); and sleep duration was divided into short (< 6 h), medium (6-9 h), and long (> 9 h). The bidirectional association between multimorbidity and sleep condition was examined using multivariate logistic regression models with adjustments for covariates.

RESULTS

Individuals with poor sleep quality showed a significantly higher prevalence of multimorbidity in the future. The adjusted OR (95% CI) values of individuals with poor sleep quality with respect to developing two diseases, three diseases, and ≥ 4 diseases were 1.39 (1.19, 1.63), 1.56 (1.23, 2.03), and 2.36 (1.68, 3.33), respectively. In addition, individuals with multimorbidity exhibited a significantly higher risk of poor sleep quality in the future. Short sleep duration led to multimorbidity in the future (OR = 1.49; 95 CI%, 1.37-1.63), while multimorbidity contributed to short sleep duration (< 6 h) in the future (OR = 1.39; 95% CI, 1.27-1.51) after full adjustment.

CONCLUSIONS

There was a bidirectional association between sleep quality or short sleep duration and multimorbidity in middle-aged and older Chinese adults. We recommend that greater attention be given to clinical management among adults with sleep disorders or physical multimorbidities.

Association of Atrial Fibrillation with Insomnia in the Elderly Population

INTRODUCTION/OBJECTIVES

Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States. We studied the association of AF with insomnia in the elderly population.

METHODS

We reviewed the electronic medical records of elderly patients who received care in an internal medicine office from July 1, 2020 through June 30, 2021. Patients were grouped into AF group, and a group without AF (NOAF). Association of insomnia and other variables were compared between the 2 groups.

RESULTS

Among 2428 patients, 341 (14%) had AF. Patients in the AF group were significantly older compared to no-AF group (80.3 ± 7.9 vs 76.1 ± 7.4 years; P < .001). A higher frequency of men was noted in AF group versus NOAF group (54.3 vs 42.0%; P < .001). The frequency of insomnia was significantly higher in AF group versus NOAF group (14.1 vs 9.5%; P < .05). Additionally, greater frequencies of associations of other comorbid medical conditions were noted in the AF group compared to NOAF group, such as cerebrovascular accident (CVA; 12.9 vs 5.4%; P < .001), transient ischemic attack (TIA; 7.0 vs 3.0%; P < .001), dementia (5.9 vs 3.3%; P < .05), coronary artery disease (CAD; 34.9 vs 18.3%; P < .001), congestive heart failure (CHF; 21.1 vs 3.8%; P < .001), other cardiac arrhythmias (53.4 vs 6.3%; P < .001), chronic obstructive pulmonary disease (COPD; 12.3 vs 5.7%; P < .001), obstructive sleep apnea (OSA; 17.6 vs 11.8%; P = .003), chronic kidney disease (CKD; 22.9 vs 11.9%; P < .001), anemia (23.2 vs 13.0%; P < .001), and cancer (36.1 vs 27.9%; P = .002). There was significantly greater odds of AF in patients who had insomnia (OR = 1.972, CI = 1.360-2.851; P < .001).

CONCLUSION

AF was associated with insomnia in the elderly population. Higher frequencies of association of AF were also seen with older age, male sex, White race, CVA, TIA, dementia, CAD, CHF, other cardiac arrhythmias, COPD, OSA, CKD, anemia, and cancer.

Non-Conventional Risk Factors: "Fact" or "Fake" in Cardiovascular Disease Prevention?

Cardiovascular diseases (CVDs), such as arterial hypertension, myocardial infarction, stroke, heart failure, atrial fibrillation, etc., still represent the main cause of morbidity and mortality worldwide. They significantly modify the patients' quality of life with a tremendous economic impact. It is well established that cardiovascular risk factors increase the probability of fatal and non-fatal cardiac events. These risk factors are classified into modifiable (smoking, arterial hypertension, hypercholesterolemia, low HDL cholesterol, diabetes, excessive alcohol consumption, high-fat and high-calorie diet, reduced physical activity) and non-modifiable (sex, age, family history, of previous cardiovascular disease). Hence, CVD prevention is based on early identification and management of modifiable risk factors whose impact on the CV outcome is now performed by the use of CV risk assessment models, such as the Framingham Risk Score, Pooled Cohort Equations, or the SCORE2. However, in recent years, emerging, non-traditional factors (metabolic and non-metabolic) seem to significantly affect this assessment. In this article, we aim at defining these emerging factors and describe the potential mechanisms by which they might contribute to the development of CVD.

Sex Differences in Neurovascular Control: Implications for Obstructive Sleep Apnea

Patients with obstructive sleep apnea (OSA) have a heightened risk of developing cardiovascular diseases, namely hypertension. While seminal evidence indicates a causal role for sympathetic nerve activity in the hypertensive phenotype commonly observed in patients with OSA, no studies have investigated potential sex differences in the sympathetic regulation of blood pressure in this population. Supporting this exploration are large-scale observational data, as well as controlled interventional studies in healthy adults, indicating that sleep disruption increases blood pressure to a greater extent in females relative to males. Furthermore, females with severe OSA demonstrate a more pronounced hypoxic burden (i.e., disease severity) during rapid eye movement sleep when sympathetic nerve activity is greatest. These findings would suggest that females are at greater risk for the hemodynamic consequences of OSA and related sleep disruption. Accordingly, the purpose of this review is three-fold: (1) to review the literature linking sympathetic nerve activity to hypertension in OSA, (2) to highlight recent experimental data supporting the hypothesis of sex differences in the regulation of sympathetic nerve activity in OSA, and (3) to discuss the potential sex differences in peripheral adrenergic signaling that may contribute to, or offset, cardiovascular risk in patients with OSA.

Insomnia, Poor Sleep Quality and Sleep Duration, and Risk for COVID-19 Infection and Hospitalization

BACKGROUND

Medical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality, and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization.

METHODS

The study used a cross-sectional survey of a diverse sample of 19,926 US adults.

RESULTS

COVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9%, respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1%, respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19-associated sleep problems, poor sleep quality, but not insomnia, was associated with COVID-19 infection (adjusted odds ratio [aOR] 1.16; 95% CI, 1.07-1.26) and COVID-19 hospitalization (aOR 1.50; 95% CI, 1.18-1.91). In comparison with habitual sleep duration of 7-8 hours, sleep durations <7 hours (aOR 1.14; 95% CI, 1.06-1.23) and sleep duration of 12 hours (aOR 1.61; 95% CI, 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U-shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed.

CONCLUSION

In a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic.

Secular Trends in Sleep Conditions in Chinese Elderly Individuals: A National Population-Based Study

Purpose

As one of the most rapidly aging countries in the world, the elderly population is expected to reach over 400 million in China by 2032. Many studies have suggested a positive association between sleep duration and adverse health events among elderly individuals. This study aimed to investigate the sleep conditions of Chinese elderly individuals between 2005 and 2018.

Patients and methods

Data for 53,013 elderly individuals were taken from five cycles of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during 2005-2018. Sex- and age-specific means and 95% confidence intervals (95% CIs) were used to estimate sleep duration trends. Changes in sleep patterns were explored during this period. The prevalence of short and long sleep durations was assessed and age-standardized by the 2010 census. Finally, self-reported sleep quality was used to determine sleep conditions from another perspective among elderly individuals.

Results

The mean sleep duration decreased from 7.87 (95% CI: 7.83-7.91) to 7.29 (95% CI: 7.25-7.33) hours between 2005 and 2018. Changes in sleep duration patterns were found during the study period. The proportion of the elderly population who slept ≤6 hours increased and that of those who slept ≥9 hours decreased noticeably over the past 13 years. The age-standardized prevalence of short sleep duration increased from 32.7% (95% CI: 32.7-32.9%) to 38.4% (95% CI: 38.3-38.5%). A significant decrease was observed in the prevalence of long sleep duration.

Conclusion

Sleep conditions are gradually shifting toward a shorter sleep duration and poorer sleep quality among Chinese elderly individuals.

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 2. How to manage high blood pressure in children and adolescents

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. Arterial hypertension is not only the most important risk factor for cardiovascular morbidity and mortality, but also the most important modifiable risk factor. Early hypertension-mediated organ damage may already occur in childhood. The duration of existing hypertension plays an important role in risk assessment, and structural and functional organ changes may still be reversible or postponed with timely treatment. Therefore, appropriate therapy should be initiated in children as soon as the diagnosis of arterial hypertension has been confirmed and the risk factors for hypertension-mediated organ damage have been thoroughly evaluated. Lifestyle measures should be recommended in all hypertensive children and adolescents, including a healthy diet, regular exercise, and weight loss, if appropriate. If lifestyle changes in patients with primary hypertension do not result in normalization of blood pressure within six to twelve months or if secondary or symptomatic hypertension or hypertension-mediated organ damage is already present, pharmacologic therapy is required. Regular follow-up to assess blood pressure control and hypertension-mediated organ damage and to evaluate adherence and side effects of pharmacologic treatment is required. Timely multidisciplinary evaluation is recommended after the first suspicion of hypertension. A grading system of the clinical evidence is included.

Sleep Loss Influences the Interconnected Brain-Body Regulation of Cardiovascular Function in Humans

OBJECTIVE

Poor sleep is associated with hypertension, a major risk factor for cardiovascular disease. However, the mechanism(s) through which sleep loss affects cardiovascular health remains largely unknown, including the brain and body systems that regulate vascular function.

METHODS

Sixty-six healthy adults participated in a repeated-measures, crossover, experimental study involving assessments of cardiovascular function and brain connectivity after a night of sleep and a night of sleep deprivation.

RESULTS

First, sleep deprivation significantly increased blood pressure-both systolic and diastolic. Interestingly, this change was independent of any increase in heart rate, inferring a vasculature-specific rather than direct cardiac pathway. Second, sleep loss compromised functional brain connectivity within the vascular control network, specifically the insula, anterior cingulate, amygdala, and ventral and medial prefrontal cortices. Third, sleep loss-related changes in brain connectivity and vascular tone were not independent, but significantly interdependent, with changes within the vascular control brain network predicting the sleep-loss shift toward hypertension.

CONCLUSIONS

These findings establish an embodied framework in which sleep loss confers increased risk of cardiovascular disease through an impact upon central brain control of vascular tone, rather than a direct impact on accelerated heart rate itself.

Isolated nocturnal hypertension in relation to host and environmental factors and clock genes

Isolated nocturnal hypertension (INH) is a special type of out-of-office hypertension. Its determinants and pathophysiology remain unclear. In a nested case-control study, we intend to investigate the host, environmental, and genetic factors in relation to INH. Among 2030 outpatients screened from December 2008 till June 2015, 128 patients with INH were identified, and then 128 normotensives were matched according to sex and age. INH was an elevated nocturnal blood pressure (BP ≥120/70 mmHg) in the presence of a normal daytime BP (< 135/85 mmHg). Host factors included age, sex, body mass index, smoking and drinking, sleep time and duration, heart rate, serum lipids, and serum creatinine. Environmental cues encompassed season, ambient temperature, atmospheric pressure, humidity, and wind speed, and genetic cues 29 single-nucleotide polymorphisms (SNPs) in 12 clock genes. Daytime and nighttime BPs averaged 124.9/80.7  and 114.5/73.7 mmHg, respectively, in the INH patients and 121.0/76.5 and 101.8/63.3 mmHg in the normotensive controls. Stepwise logistic regression analyses revealed that INH was associated with nighttime heart rate (P = .0018), sleep duration (P = .0499), and relative humidity (P = .0747). The odds ratios (95% CI) for each 10 beats/min faster nighttime heart rate and 10% lower relative humidity were 1.82 (1.25-2.65) and 0.82 (0.67-1.00), respectively. Irrespective of the genetic models, no significant association was observed between INH and the SNPs (P ≥ .054). In conclusion, INH was associated with host and environmental factors rather than genetic markers.

Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Impact of objectively-measured sleep duration on cardiometabolic health: A systematic review of recent evidence

Cardiometabolic disease is a spectrum of diseases including, cardiovascular diseases, and metabolic syndrome. It is the leading cause of morbidity and mortality worldwide, with premature deaths being preventable. Currently, sleep has emerged as a potential target for cardiometabolic disease prevention. Several epidemiological studies have provided ample evidence that objectively measured short sleep duration increases the risk of cardiometabolic disease. However, the findings are inconsistent, and few studies measure sleep duration on cardiometabolic profiles objectively. Therefore, in this review, we focused on the recently published literature that explored the association between objectively measured sleep duration and cardiometabolic profiles (cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome), seeking more insights regarding the applicability and, in turn, the impact of objectively measured sleep duration on cardiometabolic health, which is relatively understudied. We retrieved the information manually from PubMed, Google Scholar, HINARI, and the Cochrane Library from 2015 to 2022 using appropriate search terms, we included 49 articles. In this review, we found a strong relationship between objectively measured sleep duration and the risk of cardiometabolic disease, indicating that objectively measured short sleep durations increase cardiometabolic risks. In general, the association between objectively measured sleep duration and increased cardiometabolic risks (CMR) has been well-documented in higher-income countries. Several studies found that longer sleep duration was associated with a more favorable cardiometabolic profile in early adolescence, independent of other risk factors. On the other hand, objectively measured short sleep duration is associated with adverse cardiometabolic health outcomes such as coronary heart disease, hypertension, type 2 diabetes mellitus, and metabolic syndrome.