The Association Between Habitual Sleep Duration and Blood Pressure Control in United States (US) Adults with Hypertension

Figures & data

Figure 1 Flow diagram for the inclusion and exclusion criteria used in the study.

Table 1 Characteristics of NHANES Sample of US Adults with Hypertension by Habitual Sleep Duration, n=5163

Characteristic	Overall	Habitual Sleep Duration				P-value
		<6 (n=516)	6 - <7 (n=808)	7–9 (n=3214)	>9 (n=625)
Sociodemographic characteristics
Male sex, %	2662 (52.2)	56.6	61.6	51.5	39.4	<0.001
Age, mean ± SE, range	55.4 ± 0.4 (18–80)	53.3 ± 0.8 (18–80)	52.8 ± 0.7 (18–80)	55.7 ± 0.5 (18–80)	59.1 ± 0.9 (18–80)	<0.001
Race/Ethnicity, %						<0.001
Non-Hispanic White	1719 (64.3)	53.6	57.7	67.2	64.2
Non-Hispanic Black	1334 (13.0)	22.8	17.4	10.5	14.3
Hispanic	1268 (13.0)	13.6	14.6	12.4	13.5
Other race/ethnicity	842 (9.7)	10.0	10.3	9.8	8.0
US-born, %	3580 (83.0)	83.2	79.8	83.3	85.2	0.160
Education Level, %						<0.001
College graduate	1146 (27.6)	16.8	27.9	30.3	18.9
Some college	1587 (33.2)	36.4	36.2	33.5	23.5
High school graduate	1237 (25.9)	32.4	22.6	24.5	34.5
Less than high school	1187 (13.4)	14.5	13.3	11.7	23.2
Household income <$55,000, %	2966 (48.5)	61.5	40.2	46.1	65.4	<0.001
Employment Status, %						<0.001
Fulltime 35–44 hours/week	1144 (24.7)	18.1	27.7	26.9	11.4
Fulltime ≥45 hours/week	794 (19.4)	29.7	29.6	18.1	4.4
Part time <35 hours/week	630 (12.3)	9.6	10.7	13.4	9.5
Not working	2595 (43.6)	42.6	32.0	41.6	74.7
Has health insurance, %	4496 (89.5)	81.6	87.9	90.9	88.9	0.001
Health-related characteristics
Healthcare visits in past year, %						0.005
0	703 (12.7)	14.1	16.2	12.4	8.7
1–2	2320 (45.5)	47.0	47.4	46.2	37.0
>2	2130 (41.8)	38.9	36.5	41.4	54.4
Symptoms of sleep apnea, %	2773 (54.3)	61.9	59.5	52.2	54.3	0.025
Sought help for trouble sleeping, %	1603 (36.2)	49.9	33.2	34.7	38.4	0.004
Depressive symptoms, %						<0.001
Minimal or none	3600 (75.4)	61.5	79.5	78.4	61.9
Mild	790 (16.1)	23.4	12.4	15.0	22.8
Moderate to severe	416 (8.5)	15.2	8.1	6.6	15.3
BMI, mean±SE, range	31.2±0.2, 14.5–84.4	31.6±0.4, 15.7–84.4	31.9±0.3, 17.1–65.8	31.1±0.2, 14.5–74.8	30.6±0.4, 16.6–72.6	0.023
Cardiovascular disease, %	606 (10.5)	11.8	8.6	10.0	15.3	0.179
Diabetes mellitus, %	1303 (20.3)	17.9	22.1	19.1	27.7	0.027
Moderate CKD, %	524 (9.1)	7.5	7.5	8.6	16.1	<0.001
Cigarette smoking, %						<0.001
Never smoker	2853 (53.5)	44.9	55.1	54.8	50.2
Current smoker	928 (17.3)	28.6	19.1	14.6	22.4
Former smoker	1382 (29.2)	26.5	25.8	30.7	27.4
Alcohol intake, %						<0.001
None	1758 (28.5)	34.5	26.2	26.9	37.0
Moderate	1688 (38.8)	27.5	40.1	40.4	35.9
Heavy	1384 (32.7)	37.9	33.7	32.7	27.2
MET minutes/week), %						<0.001
None	1542 (25.1)	27.0	25.0	23.1	36.6
Low (<600)	737 (13.7)	11.8	9.0	15.2	12.5
Sufficient (600 to 1200)	592 (11.9)	10.4	10.3	12.5	11.5
High (>1200)	2292 (49.3)	50.8	55.7	49.2	39.5
On prescribed sleep medicine, %	323 (7.6)	8.5	4.2	7.3	13.4	0.005
On antihypertensives, %	2711 (49.6)	48.8	50.2	48.0	59.4	0.018
Controlled BP, %	954 (19.7)	13.7	22.8	19.5	21.4	0.140

Notes: Data expressed as an unweighted number of participants and weighted percentages and means. Ranges for continuous variables are unweighted.

Abbreviations: CKD, chronic kidney disease; BMI, body mass index; MET, metabolic equivalent of task.

Table 2 BP Control and Antihypertensive Medication Use in the NHANES Sample on Antihypertensive Therapy Stratified by Habitual Sleep Duration, n=2711

	Overall	<6 (n=258)	6 - <7 (n=424)	7–9 (n=1662)	>9 (n=367)	P-value
Controlled BP, %	915 (38.3)	27.2	42.8	39.3	35.2	0.118
Number of antihypertensive medications
1	1309 (51.1)	47.0	25.2	24.6	31.9	0.776
2	918 (32.3)	33.5	17.1	15.1	19.7
≥3	484 (16.6)	19.5	7.9	8.2	7.8
Specific antihypertensive medications used
Angiotensin converting enzyme inhibitor or angiotensin receptor blocker, %	1507 (28.4)	25.0	27.2	28.3	34.2	0.100
Diuretic, %	634 (11.9)	13.2	11.7	11.7	12.1	0.932
Beta-blocker, %	854 (15.5)	19.9	15.2	14.8	17.5	0.157
Calcium channel blocker, %	712 (10.4)	10.6	7.1	10.6	13.7	0.004
Combination medication, %	483 (8.6)	9.3	11.2	7.9	8.3	0.221

Note: Data expressed as an unweighted number of participants and weighted percentages.

Table 3 The Odds for BP Control in NHANES Sample of US Adults with Hypertension

	All Adults with Hypertension (n=5163)				Adults Taking Antihypertensive Medication (n=2711)
	Crude OR (95% CI)	P-value	AOR (95% CI)^a	P-value	Crude OR (95% CI)	P-value	AOR (95% CI)^b	P-value
Sleep duration
7–9	1 (Ref)		1 (Ref)		1 (Ref)		1 (Ref)
<6	0.65 (0.44–0.98)	0.041	0.53 (0.37–0.76)	0.001	0.58 (0.38–0.88)	0.012	0.53 (0.36–0.77)	0.002
6 - <7	1.22 (0.81–1.82)	0.329	1.23 (0.77–1.98)	0375	1.16 (0.71–1.87)	0.545	1.15 (0.70–1.88)	0.570
>9	1.12 (0.81–1.55)	0.479	0.93 (0.64–1.36)	0.701	0.84 (0.60–1.19)	0.310	0.95 (0.66–1.38)	0.789
Age
18–39	1 (Ref)		1 (Ref)		1 (Ref)		1 (Ref)
40–59	4.05 (2.43–6.75)	<0.001	1.66 (1.08–2.55)	0.022	1.45 (0.87–2.42)	0.152	1.43 (0.89–2.30)	0.139
60–79	7.63 (4.73–12.3)	<0.001	1.56 (0.94–2.60)	0.085	1.46 (0.85–2.52)	0.166	1.28 (0.75–2.18)	0.352
80 and older	3.03 (1.69–5.46)	0.001	0.53 (0.27–1.05)	0.068	0.52 (0.27–1.00)	0.050	0.43 (0.22–0.86)	0.019
Female (vs male)	1.38 (1.12–1.71)	0.004	1.04 (0.83–1.31)	0.731	0.97 (0.78–1.21)	0.773	1.05 (0.82–1.36)	0.680
Race/Ethnicity
Non-Hispanic White	1 (Ref)		1 (Ref)		1 (Ref)
Non-Hispanic Black	0.78 (0.61–0.99)	0.038	0.84 (0.65–1.08)	0.164	0.72 (0.56–0.92)	0.012	0.85 (0.65–1.12)	0.236
Hispanic	0.60 (0.43–0.84)	0.004	1.32 (0.89–1.97)	0.163	0.79 (0.58–1.07)	0.119	1.32 (0.88–1.96)	0.173
Other race/ethnicity	1.04 (0.77–1.40)	0.793	1.60 (1.04–2.46)	0.032	1.23 (0.87–1.73)	0.241	1.70 (1.17–2.47)	0.007
Ever sought help for sleeping difficulty (vs no)	1.73 (1.43–2.09)	<0.001	1.13 (0.90–1.42)	0.275	1.24 (1.00–1.54)	0.047	1.13 (0.91–1.41)	0.255
Sleep apnea symptoms (vs none)	0.99 (0.83–1.19)	0.934	0.92 (0.76–1.11)	0.355	0.99 (0.80–1.24)	0.963	0.89 (0.72–1.11)	0.291
Cardiovascular disease (vs no cardiovascular disease)	2.51 (1.82–3.45)	<0.001	1.37 (0.93–2.03)	0.111	1.17 (0.85–1.61)	0.314	1.31 (0.93–1.84)	0.116
Diabetes (vs no diabetes)	2.19 (1.60–2.99)	<0.001	1.08 (0.78–1.51)	0.632	1.07 (0.76–1.51)	0.697	1.02 (0.73–1.43)	0.886
Moderate CKD (vs no moderate CKD)	2.40 (1.58–3.66)	<0.001	1.62 (1.01–2.62)	0.048	1.25 (0.77–2.03)	0.355	1.58 (0.98–2.54)	0.059
Depressive symptoms
Minimal or none	1 (Ref)		1 (Ref)		1 (Ref)		1 (Ref)
Mild	1.24 (0.87–1.76)	0.227	1.16 (0.81–1.67)	0.402	1.06 (0.73–1.56)	0.746	1.16 (0.79–1.71)	0.437
Moderate to severe	1.47 (0.95–2.28)	0.080	1.40 (0.79–2.476)	0.241	1.09 (0.69–1.73)	0.691	1.28 (0.79–2.08)	0.306
Prescription sleep medication use	1.46 (1.00–2.11)	0.048	0.84 (0.52–1.37)	0.470	0.91 (0.60–1.37)	0.631	0.81 (0.54–1.24)	0.323

Notes: Estimates weighted using mobile examination center (MEC) sample weights. ^aAdjusted for all covariates in the table plus current use of antihypertensive medications, cigarette smoking status, alcohol intake, MET minutes per week, BMI, nativity, health insurance, employment status, healthcare visits in the past year, annual household income, and education level. ^bAdjusted for all covariates in the table plus types and number of antihypertensive medications respondent was currently on, cigarette smoking status, alcohol intake, MET minutes per week, BMI, nativity, health insurance, employment status, healthcare visits in the past year, annual household income, and education level.

Abbreviations: NHANES, National Health and Nutrition Examination Survey; SE, standard error; AOR, adjusted odds ratio; BMI, body mass index; MET, metabolic equivalent of task; CKD, chronic kidney disease.