Association Of Sleep Duration With Blood Pressure And Hypertension In Chinese Adults

ObjectiveThe study aimed to master the current situation of sleep duration,the distribution of blood pressure and the prevalence of hypertension in different characteristics of Chinese adults,and to provide epidemiological reference data for the study of sleep medicine and hypertension in China.By analyzing the relationship between sleep duration with blood pressure and the relationship between sleep duration with hypertension in different subgroups of adults in China,we can understand the influence of sleep duration on blood pressure and hypertension,and provide scientific basis for formulating and evaluating hypertension prevention and control strategies and measures.MethodsThis study used data from China Chronic Disease and Nutrition Surveillance in 2015,which was carried out in 298 surveillance points in 31 provinces(including autonomous regions and municipalities)in China’s mainland.Multi-stage cluster random sampling method was used to select subjects.Information on sociodemographic characteristics,behavioural risk factors,chronic disease status and sleep status were collected through a questionnaire by face-to-face interview.The height,weight and blood pressure of each subject were measured in the investigation field.In the data analysis,all the mean values and constituent ratios/rates were calculated by complex weighting.The counting data were represented by frequencies,composition ratios/rates and 95%confidence intervals(95%CI).The measurement data were expressed in mean value and standard deviation.Rao-Scott χ2 tests which were based on the complex sampling design were conducted to test for group differences in prevalence or percentage,and the logistic regression models were used to examine the trends for ordered categorical variables.Univariate linear regression was used to compare differences in blood pressure levels in different subgroups.Piecewise multiple linear regression models were used to analyze the different effects of sleep duration on systolic pressure,diastolic pressure and pulse pressure.Multilevel logistic regression models were used to analyze the relationship between sleep duration and hypertension.ResultsThe effective sample size for analysis in this study from China Chronic Disease and Nutrition Surveillance in 2015 was 177770,of which 83148 were males,accounting for 50.3%,and 94622 were females,accounting for 49.7%.The proportion of Chinese residents who slept for 8-8.9 hours per day was the highest,accounting for 38.2%,followed by 7-7.9 hours,accounting for 23.5%.The proportions of subjects who slept for less than 6 hours and more than 10 hours were higher in females than those in males.The prevalence of hypertension in adult residents in China was 29.2%with a higher prevalence in males(31.9%)than in females(26.4%).The prevalence of hypertension increased with age in both males and females(P<0.05).In 2015,subjects who slept for 8-8.9 hours per day had the lowest systolic and pulse pressures,which were 127.20(SD=19.01)mmHg and 50.08(SD=13.51)mmHg,respectively,while those with 9-9.9 hours of sleep duration per day had the lowest diastolic blood pressure,which was 76.92(SD=11.24)mmHg.Piecewise multiple linear regression models showed that when sleep duration ranged from 4-7.6 hours a day,systolic blood pressure increased by 1.13 mmHg with every hour of reduced sleep duration.When sleep duration ranged from 7.7-16 hours a day,systolic blood pressure increased by 1.02 mmHg with every hour of increased sleep duration.When sleep duration ranged from 4-8.3 hours a day,diastolic blood pressure increased by 0.18 mmHg with every hour of reduced sleep duration.When sleep duration ranged from 84-16 hours a day,no statistically significant association between sleep duration and diastolic blood pressure was observed.When sleep duration ranged from 4-7.5 hours a day,pulse pressure increased by 1.10 mmHg with every hour of reduced sleep duration.When sleep duration ranged from 7.6-16 hours a day,pulse pressure pressure increased by 0.88 mmHg with every hour of increased sleep duration.There was a U-shaped relationship between sleep duration and hypertension.Females who slept for less than 6 hours had a signifcantly greater likelihood of hypertension than males as the reference group of 8-8.9 hours after adjustment for covariates(Female OR=1.53,95%CI:138,1.71;Male OR=1.20,95%CI:1.01,1.34).Males who slept for more than 10 hours had a signifcantly greater likelihood of hypertension than females(Male OR=1.28,95%CI:1.15,1.42;Female OR=1.12,95%CI:1.03,1.22).Among those aged 18-44 years,greater likelihoods of hypertension were observed for those who slept for less than 6 hours a day(OR=1.11,95%CI:1.05,1.24).No statistically significant association between sleep duration and hypertension was observed among those aged 45-59 years.Among those aged 60 years or above,greater likelihoods of hypertension were observed for those who slept for more than 10 hours a day(OR=1.17,95%CI:1.06,1.30).In different BMI subgroups,normal-weight residents who slept for less than 6 hours and more than 10 hours a day were associated with hypertension.In overweight/obese residents,greater likelihoods of hypertension were observed for those who slept for less than 6 hours a day.Residents with insomnia who slept for less than 6 hours had a greater likelihoods of hypertension than those without insomnia.The OR values for residents with insomnia and without insomnia who slept for more than 10 hours were 1.20(95%CI:1.11,1.29)and 1.18(95%CI:1.03,1.32),respectively.Patients with hypertension who did not take antihypertensive drugs with sleep duration of less than 6 hours and more than 10 hours had a signifcantly greater likelihood than those who took antihypertensive drugs.ConclusionThere was a relationship between sleep duration and systolic blood pressure as well as pulse pressure.There was a U-shaped relationship between sleep duration and hypertension in Chinese adults in 2015.The relationship between sleep duration and hypertension in different subgroups such as gender,age groups,BMI and sleep conditions present different characteristics.The OR values between short sleep duration and hypertension in women was higher than those in men.Short sleep duration was associated with hypertension in 18-44 years old residents and in overweight/obesity residents.Longer sleep duration was associated with hypertension in residents aged 60 and above.The relationship between sleep duration and hypertension in residents with insomnia was stronger than those without insomnia.The relationship between sleep duration and hypertension in patients with hypertension who did not take antihypertensive drugs was stronger than those who took antihypertensive drugs.Health-related departments should increase the awareness of sleep and hypertension of the public,strengthen the promotion and education of sleep hygiene knowledge and hypertension prevention and control knowledge,so that people can maintain an appropriate sleep duration,and then continuously improve blood pressure from the perspective of sleep.