Short Sleep Duration is Associated with Hypertension only among Women: A Population-based Study

1. Short Sleep Duration is Associated with Hypertension only among Women: A Population-based Study Stranges S *, Dorn JM *, Cappuccio FP*, Donahue RP *, Hovey KM *, Kandala N-B *, Miller MA *, Trevisan M * *University of Warwick Medical School, UK *State University of New York at Buffalo, USA E.S.R.S. Glasgow 2008

2. Sleep Duration & Chronic Disease Total and Cause-Specific Mortality A decrease in sleep duration is associated with an increase in mortality via cardiovascular deaths(Ferrie JE et al. Sleep 2007;30:1659-66) Cardio-Metabolic Risk Factors/Disease Obesity/Body Fat Distribution (Gangwisch JE et al. Sleep 2005;28:1289-96 - Patel SR et al. A.J.E. 2006;164:947-54 – Stranges S et al. A.J.E. 2008;167:321-9 - Cappuccio FP et al. Sleep 2008;31:619-26) Type 2 Diabetes (Ayas NT et al. Diab Care 2003;26:380-4 – Yaggi HK et al. Diab Care 2006;29:657-61) Coronary Heart Disease (Meisinger C et al. Sleep 2007;30:1121-7) Hypertension (Gangwisch JE et al. Hypertension 2006;47:833-9 - Cappuccio FP et al. Hypertension 2007;50:693-701 - Stang A et al. Hypertension 2008;51:e15-6)

3. Study Aims To examine the cross-sectional association of sleep duration with hypertension To perform gender-specific analyses with the inclusion of a number of potential confounding variables

4. Setting Erie & Niagara Counties Baseline examination (Sept 1996 – May 2001) Eligible Participants: a) cancer free; b) age 35-79 years Actual Participants: 4,065, random sample Participation rate: 59.5% Exclusion Criteria Self-reported history of prevalent CVD, ethnicity other than white Included: 3,207 participants (56.5% women) General examination Resting blood pressure, BMI, waist circumference, abdominal height Socio-demographics Marital status, education, annual household income Lifestyle Diet, drinking and smoking habits, physical activity, sleep habits Health Status SF-36 mental/physical, depressive symptoms (CES-D), diabetes The Western New York Health Study

5. Exposure: Sleep Duration Seven-Day Physical Activity Recall questionnaire ‘On the average, how many hours did you sleep each night in the last five weekday nights (Sunday-Thursday)?’ Short sleep (<6 hours) Mid-range sleep (6-8 hours) Long sleep (>8 hours) Outcome: Prevalent Hypertension Systolic BP ≥ 140 mmHg,ORDiastolic BP ≥ 90 mmHg, ORon antihypertensive medication at the baseline visit Statistical analysis Multivariable logistic regression Model 1: age, education, marital status, household income Model 2: M1 + BMI/waist, drinking/smoking, physical activity Model 3: M2 + SF-36 mental/physical, depressive symptoms Odds ratios of prevalent HTN comparing short and long duration of sleep vs. mid-range category

6. Exposure: Sleep Duration Seven-Day Physical Activity Recall questionnaire ‘On the average, how many hours did you sleep each night in the last five weekday nights (Sunday-Thursday)?’ Short sleep (<6 hours) Mid-range sleep (6-8 hours) Long sleep (>8 hours) Outcome: Prevalent Hypertension Systolic BP ≥ 140 mmHg,ORDiastolic BP ≥ 90 mmHg, ORon antihypertensive medication at the baseline visit Statistical analysis Multivariable logistic regression Model 1: age, education, marital status, household income Model 2: M1 + BMI/waist, drinking/smoking, physical activity Model 3: M2 + SF-36 mental/physical, depressive symptoms Odds ratios of prevalent HTN comparing short and long duration of sleep vs. mid-range category

7. Exposure: Sleep Duration Seven-Day Physical Activity Recall questionnaire ‘On the average, how many hours did you sleep each night in the last five weekday nights (Sunday-Thursday)?’ Short sleep (<6 hours) Mid-range sleep (6-8 hours) Long sleep (>8 hours) Outcome: Prevalent Hypertension Systolic BP ≥ 140 mmHg,ORDiastolic BP ≥ 90 mmHg, ORon antihypertensive medication at the baseline visit Statistical analysis Multivariable logistic regression Model 1: age, education, marital status, household income Model 2: M1 + BMI/waist, drinking/smoking, physical activity Model 3: M2 + SF-36 mental/physical, depressive symptoms Odds ratios of prevalent HTN comparing short and long duration of sleep vs. mid-range category

8. Baseline Characteristics (n=3,027) Sleep categories (%) Hypertension (%)

9. Covariates by Sleep Duration Categories (Women n=1,710)

10. Covariates by Sleep Duration Categories (Men n=1,317)

11. Odds Ratios (OR) of Hypertension in Women Model 1: age, education, marital status, household income

12. Odds Ratios (OR) of Hypertension in Women Model 2: M1 + BMI/waist, drinking/smoking, physical activity

13. Odds Ratios (OR) of Hypertension in Women Model 3: M2 + SF-36 mental/physical, depressive symptoms

14. Odds Ratios (OR) of Hypertension in Women

15. Odds Ratios (OR) of Hypertension in Men

16. Summary Short sleepduration associated with hypertension only in women Thisassociation was independent of SES, CVD risk factors, general health status, and psychiatric co-morbidities Stronger in pre-menopausal women

17. Increased BP load while awake Activation of sympathetic nervous system Increased renal sodium retention Gender-specific effects? Hormonal influences/psychosocial stressors Differential self-reporting of sleep habits Confounding/co-morbidities Consider limitations of cross-sectional studies Sleep Deprivation & Hypertension:Potential Mechanisms

18. Conclusions • Sleep deprivation may produce more detrimental effects on cardiovascular health in women than men • Need for mechanistic/prospective evidence • Objective assessment of sleep changes over time • Better understanding of determinants of sleep duration • Short sleep duration as a marker of health status/quality of life