Original ArticleEpidemiological evidence for the link between sleep duration and high blood pressure: A systematic review and meta-analysis
Introduction
Hypertension is a major public health epidemic all over the world, with increasing prevalence both among adults and children [1], [2], [3], [4]. Nearly seven million deaths worldwide are attributed to high blood pressure (BP) each year [5]. Hypertension has been found to be a risk factor for ischemic heart disease, stroke, and cardiac and renal failure [6], [7]. Recognition of risk factors for hypertension and modification of lifestyle habits would lead to earlier prevention and better control of high BP.
Sleep plays an important role in the daily life of adults and the growth of children and adolescents. Several studies have suggested that suboptimal sleep duration is associated with adverse health outcomes, including morbidity and mortality [8], [9], [10], cardiovascular disease [8], [11], type 2 diabetes mellitus [12] and obesity [13]. There also is increasing evidence indicating a link between sleep duration and BP. Sleep deprivation has been observed to be related to significant increases in BP both in normotensive and hypertensive subjects [14], [15]. Improving sleep duration and quality could result in the reduction of both daytime and nighttime BPs [16], [17]. The underlying mechanism might include changes of the sympathetic nervous system, circadian rhythm, and concentrations of hormones [15], [18], [19].
Although many epidemiological studies have examined the association between sleep duration and hypertension on a population level, the results have been inconsistent. To our knowledge, there has been no meta-analysis conducted to investigate this relationship quantitatively and to test the potential differences by population categories such as age and gender. Therefore, we performed our study to assess the association between sleep duration and high BP among the general population of adults through: (1) a systematic review of all relevant studies, (2) a meta-analysis to obtain a quantitative estimate of the risk, and (3) a further analysis by population groups to assess the possible diversity.
Section snippets
Literature search
We conducted a comprehensive systematic search using PubMed and the Cochrane Library through February 2012. Search strategies included medical subject heading (MeSH) words and text words without language restrictions. The terms used for searching were sleep, hypertension, and blood pressure. Furthermore, we reviewed reference lists of original and relevant reviews to ascertain additional studies. If the articles did not contain all of the necessary contents, we contacted the authors directly to
Search results
The initial database search generated 5270 papers, of which 5223 were excluded after review of the title and abstract. Among the retrieved 47 articles, 23 articles met our inclusion criteria [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43]. In the updated search, one article published after the original search date was identified and included in the review [43]. Fig. 1 provides a diagram of the
Discussion
Our study provided for the first time a comprehensive review of the literature and quantitative estimates of both cross-sectional and longitudinal associations between short and long sleep duration and hypertension among population-based studies of adults worldwide. We found an increased risk for developing hypertension on either end of the distribution of sleep duration at the cross-sectional level, indicating the presence of a U-shaped association among adults. However, longitudinally only
Conflict of Interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2012.12.001.
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