Abstract
Sleep difficulties and short sleep duration have been associated with hypertension. Though body mass index (BMI) may be a mediator variable, the mediation effect has not been defined. We aimed to assess the association between sleep duration and sleep difficulties with hypertension, to determine if BMI is a mediator variable, and to quantify the mediation effect. We conducted a mediation analysis and calculated prevalence ratios with 95% confidence intervals. The exposure variables were sleep duration and sleep difficulties, and the outcome was hypertension. Sleep difficulties were statistically significantly associated with a 43% higher prevalence of hypertension in multivariable analyses; results were not statistically significant for sleep duration. In these analyses, and in sex-specific subgroup analyses, we found no strong evidence that BMI mediated the association between sleep indices and risk of hypertension. Our findings suggest that BMI does not appear to mediate the association between sleep patterns and hypertension. These results highlight the need to further study the mechanisms underlying the relationship between sleep patterns and cardiovascular risk factors.
Highlights
To lessen the global burden of cardiovascular diseases, it is crucial that rates of hypertension and other cardiovascular risk factors are reduced [1, 2]
It has been suggested that body mass index (BMI) and obesity are partial mediators of the association between hypertension and sleep duration [9,10,11]
The overall prevalence of hypertension was 18.2%
Summary
To lessen the global burden of cardiovascular diseases, it is crucial that rates of hypertension and other cardiovascular risk factors are reduced [1, 2]. Important risk factors for hypertension include short sleep duration and sleep difficulties [3,4,5]. Randomized controlled trials have shown a reduction in blood pressure as well as in cardiovascular events in patients with obstructive sleep apnea treated with continuous positive airway pressure [7, 8]. These studies did not include weight management as a key treatment to improve the effect of sleep health on blood pressure. The increased hunger may be satisfied by unhealthy food choices that impair cardiovascular health, which could potentially increase arterial stiffness, an effect that is caused by sleep problems themselves [12]
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