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Association of Short Sleep Duration and Hypertension: The ELSA-Brasil study.
Short sleep duration (SD) has been associated with hypertension (HTN). However, most of these studies evaluated SD in a subjective way and did not explore the potential influence of another sleep disorder, namely obstructive sleep apnea (OSA).
To explore the association of subjective and objective SD with prevalent HTN and blood pressure (BP) levels in the ELSA-Brasil study, a cohort of adult civil servants.
Consecutive participants performed a clinical evaluation including data on subjective SD. For capturing objective SD, we used pulse actigraphy for 1 week (Actiwatch 2TM). A home portable sleep monitor (Embletta GoldTM) for one night was used to evaluate the presence of OSA. The SD was stratified in the following categories: <5hs, 5-6hs, 6-7hs (reference group) and >7hs. OSA was defined by an apnea-hypopnea index ≥15 events/hour. BP was measured 3 times in the seated position after 5 minutes of rest (the mean of two last measurements were used for the analysis). HTN was defined by a BP ≥140x90mmHg or previous use of antihypertensive medications. A multivariate analysis was used to determine the independent associations of the SD categories with HTN (primary endpoint) and BP values (secondary endpoints). We built 4 models of adjustments: Model 1: unadjusted; Model 2: adjusted for age, gender, race, body mass index (BMI), alcoholism, and antihypertensive medications (the latter variable was used only for BP endpoint); Model 3: model 2 + subjective insomnia and sleep efficiency; Model 4: model 3 + OSA.
We studied 2,010 participants (age 49±8 years; BMI: 27.1±4.7Kg/m2, 42.6% of men). The frequency of subjective SD <5hs, 5-6hs, 6-7hs, and >7hs were 4.0, 43.3, 30.2, and 22.4%, respectively. The frequency of objective SD <5hs, 5-6hs, 6-7hs, and >7hs were 5.5, 21.8, 41.4 and 31.3%, respectively. OSA was observed in 658 participants (32.7%). The frequency of HTN was 26.1 % (525 participants). Participants with both subjective and objective SD<5hs had a higher frequency of HTN than the remaining groups. Consistently, systolic and diastolic BP values were higher in the objective SD<5hs group. In the fully adjusted multivariate analysis, no single SD category (for subjective or objective data) was independently associated with HTN or BP values.
Both subjective and objective SD are not associated with HTN and BP levels in the ELSA-Brasil cohort.
obstructive sleep apnea, sleep duration, hypertension.
Center of Clinical and Epidemiologic Research - Sao Paulo - Brasil, Heart Institute - University of São Paulo - Sao Paulo - Brasil, Hypertension Unit and Renal Division - University of São Paulo - Sao Paulo - Brasil
Barbara K Parise, Arthur E Mesas, Ronaldo B Santos, Wagner A Silva, Silvana P Souza, Soraya Giatti, Luiz A Bortolotto, Paulo A Lotufo, Isabela M Bensenor, Luciano F Drager