Abstract
ABSTRACTObjective: To review the epidemiological evidence of the association between sleep duration and blood pressure in adolescents.Data sources: We performed a systematic review of observational studies in Medline, Scopus, Lilacs, Web of Science, Science Direct databases and Virtual Libraries in English, Spanish and Portuguese published until September 2018. Studies were selected first by title and abstract, then by complete reading, according to the eligibility criteria. The reference list of selected articles was evaluated in order to retrieve relevant studies.Data synthesis: Initially, 1,455 articles were retrieved. After exclusion due to duplicity or not meeting the eligibility criteria, 13 articles were included in the review. Studies varied greatly in sample size (143 to 6,940 patients), methods of measuring blood pressure and sleep duration, cutoff points, categorization and adjustment of variables. The main evidence from the studies is that short sleep duration is associated with high blood pressure in adolescence, although the presence of association between high blood pressure and long sleep duration is possible, but not clear in the literature.Conclusions: Sleep duration, especially short duration, is associated with high blood pressure in adolescents. Such evidence draws attention to implications on cardiovascular health in this age group.
Highlights
High blood pressure, which has been identified as a major public health epidemic,[1,2] is an important risk factor for cardiovascular disease and is increasingly evident in children and adolescents.[3,4,5]
A total of 68 potentially relevant articles for full reading were pre-selected. Based on their complete reading, 56 were excluded because they had an ineligible outcome and/or exposure, an ineligible or unspecified age group, they did not present measures that outlined any association between the variables sleep duration and blood pressure, or they did not report the method of measuring sleep duration and/or blood pressure
The method of measuring sleep duration is important for the robustness of the results, since subjective methods such as self-reporting, parental reporting, questionnaires or sleep diaries can overestimate or underestimate the measure of sleep duration,[9,27, 28,33] while the objective measurement of sleep duration, performed through polysomnography, is considered to be the gold standard.[34]
Summary
High blood pressure, which has been identified as a major public health epidemic,[1,2] is an important risk factor for cardiovascular disease and is increasingly evident in children and adolescents.[3,4,5] The results of the Study of Cardiovascular Risks in Adolescents (Estudo dos Riscos Cardiovasculares em Adolescentes ERICA), conducted in Brazil, showed that 24% of adolescents have high blood pressure (prehypertension or hypertension) and 10% were classified as hypertensive.[5] In addition, high blood pressure in adolescence can contribute to hypertension and heart disease in adulthood.[6]. The average sleep duration for teenagers ranges from nine hours a day at age 13 to 8.25 hours a day at age 17.8 in addition to physiological factors, social issues, such as the fast pace of modern life, and behavioral issues, such as the use of technology mainly at night, have contributed to reducing the average duration of sleep, especially among teenagers.[9,10,11] On average, teenagers sleep less than 8 hours a night,[10,11] as published in the multicenter study with teenagers entitled Healthy Lifestyle in Europe by Nutrition in Adolescence Study (HELENA), in which 33% of participants aged 12 to 17 years old reported sleeping
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