Poor Sleep Quality Linked to Greater Blood Pressure in Adults with Optimal Sleep Duration

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A study discovered an individual’s simple subjective feeling of poor sleep quality was linked to increased systolic blood pressure in participants aged ≤ 49 years with optimal sleep duration.¹

Prior studies assessing the link between subjective sleep quality and blood pressure failed to consider sleep duration.² Typically, poor sleep quality occurs in combination with short sleep duration, but this is not always the case.

In a cross-sectional study, investigators sought to investigate whether poor sleep quality was linked to increased blood pressure in individuals with optimal sleep duration.¹ The analysis intended to compare systolic and diastolic blood pressures in participants with poor versus good subjective sleep quality.

“To our knowledge, our study is the first to focus on individuals with optimal sleep duration and to suggest that an individual’s simple subjective feeling of poor sleep quality may be a marker for increased blood pressure even in these individuals,” wrote investigators, led by Kenshu Taira, from the department of Public Health and Epidemiology at the Graduate School of Medicine, University of the Ryukyus in Japan.

The study included 169 residents (91 females) aged ≥ 18 years who lived in the Western-most remote island of Okinawa, Japan and had a sleep duration of 6 to 7.9 hours per day on weekdays. Participants were from the Yonaguni Island study where they completed 2 self-administered questionnaires: the investigator’s questionnaire and the Yonaguni dietary survey questionnaire that the Yonaguni municipal government had originally included in the health check-up. The study excluded individuals if they reported sleeping < 6 or ≥ 8 hours per day on weekdays, taking sleep or antihypertensive medications, or were night-shift workers.

Participants completed a Japanese-translated Pittsburgh Sleep Quality Index (PSQI). Nearly a third of participants (30.2%) reported having a poor sleep quality. Investigators also collected data on age, alcohol drinking habits, smoking habits, behavior for lowering salt intake, and medical history.

An analysis adjusted for age, sex, and sleep duration within optimal levels found that participants aged ≤ 49 years with good sleep quality had mean systolic and diastolic blood pressures of 121.0 mm Hg (95% confidence interval [CI], 114.7 – 127.3) and 68.7 mm Hg (95% CI, 63.8 – 73.6%), respectively. Among participants in this age group with poor sleep quality, mean systolic and diastolic blood pressures were 127.8 mm Hg (95% CI, 120.7 - 134.9; P = .01) and 71.8 mm Hg (95% CI, 66.2 - 77.3; P = .14), respectively.

Among participants aged ≥ 50 years, the mean systolic and diastolic blood pressures were 130.6 mm Hg (95% CI, 121.3 - 139.8) and 79.1 mm Hg (95% CI, 73.5 - 84.7) in the good quality group and 126.9 mm Hg (95% CI, 114.6 - 139.2) and 78.0 mm Hg (95% CI, 70.5 - 85.4) in the poor-quality group (P = .43 and P = .68, respectively). The study showed a significant association between simple subject sleep quality and age for systolic blood pressure (P = .04).

Investigators found only participants in the young to early middle-aged category with poor sleep quality had greater systolic blood pressure levels compared with those with good sleep quality.

“This phenomenon may be partially explained by the sympathetic nervous system being less responsive to stimuli with increasing age,” investigators hypothesized.

The team wrote that the findings were limited by non-standardized blood pressure measurements, the lack of data on sleep apnea, measurement timing, and objective salt intake, and lastly only including participants on a remote island which may limit the generalizability of the results to other settings.

“These findings highlight the importance of easily assessing simple subjective sleep quality in clinical settings even in individuals with optimal sleep duration, in order to prevent and manage hypertension,” investigators concluded.

References

1. ^{Taira K, Fukumine Y, Nakamura K. Simple Subjective Sleep Quality and Blood Pressure in Individuals With Optimal Sleep Duration: A Cross-Sectional Study. J Clin Med Res. 2024 Dec;16(12):600-607. doi: 10.14740/jocmr6136. Epub 2024 Dec 20. PMID: 39759490; PMCID: PMC11699869.}
2. ^{Chen S, Song X, Shi H, Li J, Ma S, Chen L, Lu Y. et al. Association between sleep quality and hypertension in Chinese adults: a cross-sectional analysis in the Tianning cohort. Nat Sci Sleep. 2022;14:2097–2105. doi: 10.2147/NSS.S388535.}