Elsevier

Sleep Medicine

Volume 14, Issue 4, April 2013, Pages 324-332
Sleep Medicine

Original Article
Epidemiological evidence for the link between sleep duration and high blood pressure: A systematic review and meta-analysis

https://doi.org/10.1016/j.sleep.2012.12.001Get rights and content

Abstract

Objectives

We aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively.

Methods

We performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed.

Results

Twenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106 years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09–1.34; P < 0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04–1.18; P = 0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06–1.42; P = 0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91–1.14; P = 0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity.

Conclusions

Among adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor.

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.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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