Correlation between sleep duration and hypertension: a dose-response meta-analysis

ABSTRACT To deeply investigate the correlation between sleep duration and hypertension. The electronic databases Cochrane Library, Pubmed and Embase updated to December 2017 were retrieved,

and manual searching for paper-based documents was also performed. After studies were selected according to the predefined screening criteria, their qualities were assessed using

Newcastle-Ottawa Scale. Based on R 3.43 software, the association between sleep duration and hypertension was analyzed by dose-response meta-analysis, using relative risk (RR) and 95%

confidence interval (95% CI) as effect indexes. Furthermore, publication bias of the eligible studies was evaluated using Egger’s test. In addition, sensitivity analysis was conducted

through ignoring one study per time and then observing its influences on the pooled results. A total of 9 studies (involving 48525 objects) were included in this dose-response meta-analysis,

which had high qualities. The differences in ≤5 h vs. 7 h, 6 h vs. 7 h, and 9 h vs. 7 h groups had statistical significances, suggesting that hypertension risk was higher for shorter sleep

duration (_P_ < 0.05). There was no significant difference in >9 h vs. 7 h group. No publication bias was found for the eligible studies, indicating that our results were highly

credible (_t_ = 0.030, _P_ = 0.9766). However, the pooled results were reversed after ignoring each included study per time. Dose-response meta-analysis showed that the hypertension risk

reduced for 0.3207% when the sleep duration increased by 1 h. Shorter sleep duration contributes to the increase of hypertension risk. Access through your institution Buy or subscribe This

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THE ASSOCIATION BETWEEN SLEEP DURATION AND HYPERTENSION: A META AND STUDY SEQUENTIAL ANALYSIS Article 25 June 2020 SLEEP AND HYPERTENSION – UP TO DATE 2024 Article 16 August 2024 EXPLORING

THE RELATIONSHIP BETWEEN SLEEP CHARACTERISTICS AND CARDIOVASCULAR BIOMARKERS AMONG ADULTS AGED 46–85 YEARS MEASURED IN THE DOETINCHEM COHORT STUDY Article Open access 27 May 2025 REFERENCES

* Riley M, Bluhm B. High blood pressure in children and adolescents. Am Fam Physician. 2012;85:693. PubMed  Google Scholar  * Lackland DT, Weber MA. Global burden of cardiovascular disease

and stroke: hypertension at the core. Can J Cardiol. 2015;31:569–71. Article  PubMed  Google Scholar  * Mendis S, Puska P, Norrving B. Global atlas on cardiovascular disease prevention and

control. Geneva: World Health Organization, 2011. * Hernandorena I, Duron E, Vidal J, Hanon O. Treatment options and considerations for hypertensive patients to prevent dementia. Expert Opin

Pharmacother. 2017;18:989–1000. Article  CAS  PubMed  Google Scholar  * Guptamalhotra M, Banker A, Shete S, Hashmi SS, Tyson JE, Barratt MS, et al. Essential hypertension vs. secondary

hypertension among children. Am J Hypertens. 2015;28:73–80. Article  Google Scholar  * Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet. 2015;386:801–12. Article  PubMed  Google

Scholar  * Sox HC. Assessing the trustworthiness of the guideline for management of high blood pressure in adults. JAMA. 2014;311:472–4. Article  CAS  PubMed  Google Scholar  * Mensah GA,

Bakris GTreatment. and Control of high blood pressure in adults. Cardiol Clin. 2010;28:609–22. Article  PubMed  Google Scholar  * Campbell NR, Lackland DT, Lisheng L, Niebylski ML, Nilsson

PM, Zhang XH. Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a

resource from the World Hypertension League. J Clin Hypertens. 2015;17:165–7. Article  Google Scholar  * Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al.

Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006;29:1009–14. Article  PubMed  Google Scholar  * Vgontzas AN, Liao D, Bixler EO, Chrousos GP,

Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009;32:491–7. Article  PubMed  PubMed Central  Google Scholar  *

Fernandezmendoza J, Vgontzas AN, Liao D, Shaffer ML, Velabueno A, Basta M, et al. Insomnia with objective short sleep duration and incident hypertension: the penn state cohort. Hypertension.

2012;60:929. Article  CAS  Google Scholar  * Stranges S, Dorn JM, Cappuccio FP, Donahue RP, Rafalson LB, Hovey KM, et al. A population-based study of reduced sleep duration and

hypertension: the strongest association may be in premenopausal women. J Hypertens. 2010;28:896–902. Article  CAS  PubMed  Google Scholar  * Eguchi K, Pickering TG, Schwartz JE, Hoshide S,

Ishikawa J, Ishikawa S, et al. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med. 2008;168:2225–31. Article 

PubMed  Google Scholar  * Jf VDB, Tulen JH, Neven AK, Hofman A, Miedema HM, Witteman JC, et al. Sleep duration and hypertension are not associated in the elderly. Hypertension. 2007;50:585.

Article  Google Scholar  * Wang Q, Xi B, Liu M, Zhang Y, Fu M. Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res.

2012;35:1012–8. Article  PubMed  Google Scholar  * Guo X, Zheng L, Wang J, Li Y, Xingang Z, et al. Epidemiological evidence for the links between sleep duration and high blood pressure: a

systematic review and meta-analysis. Sleep Med. 2013;14:324. Article  PubMed  Google Scholar  * Meng L, Zheng Y, Hui R. The relationship of sleep duration and insomnia to risk of

hypertension incidence: a meta-analysis of prospective cohort studies. Hypertens Res. 2013;36:985–95. Article  PubMed  PubMed Central  Google Scholar  * Stang A. Critical evaluation of the

Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5. Article  PubMed  Google Scholar  * Lau J, Ioannidis JP,

Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med. 1997;127:820–6. Article  CAS  PubMed  Google Scholar  * Higgins J, Thompson SG, Deeks JJ, Altman DG. Measuring

inconsistency in meta-analyses. Bmj. 2003;327:557–60. Article  PubMed  PubMed Central  Google Scholar  * Egger M, Smith GD, Phillips AN. Principles and procedures. Br Med J. 1997;315:1533–7.

Article  CAS  Google Scholar  * Christian R, Florent B, Streibig JC, Daniel G. Dose-response analysis using R. PLoS One. 2015;10:e0146021. Article  Google Scholar  * Hallin M, Puri ML. A

multivariate Wald-Wolfowitz rank test against serial dependence. Can J Stat. 2010;23:55–65. * Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear

dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175:66. Article  PubMed  Google Scholar  * Fung MM, Peters K, Ancoli-Israel S, Redline

S, Stone KL, Barrett-Connor E. Total sleep time and other sleep characteristics measured by actigraphy do not predict incident hypertension in a cohort of community-dwelling older men. J

Clin Sleep Med. 2013;9:585–91. PubMed  PubMed Central  Google Scholar  * Gangwisch JE, Heymsfield SB, Bodenalbala B, Buijs RM, Kreier F, Pickering TG, et al. Short sleep duration as a risk

factor for hypertension analyses of the first national health and nutrition examination survey. Hypertension. 2006;47:833. Article  CAS  PubMed  Google Scholar  * Kim SJ, Lee SK, Kim SH, Yun

CH, Kim JH, Thomas RJ, et al. Genetic association of short sleep duration with hypertension incidence--a 6-year follow-up in the Korean genome and epidemiology study. Circ J.

2012;76:907–13. Article  PubMed  Google Scholar  * Lopez-Garcia E, Mhpharm RF, Pilar Guallar-Castillon MD, Leon-Muñoz L, Banegas JR, Fernando Rodriguez-Artalejo MD. Self-reported sleep

duration and hypertension in older spanish adults. J Am Geriatr Soc. 2009;57:663–8. Article  PubMed  Google Scholar  * Lu Y, Lu M, Dai H, Yang P, Smithgagen J, Miao R, et al. Lifestyle and

risk of hypertension: follow-up of a young pre-hypertensive cohort. Int J Med Sci. 2015;12:605–12. Article  CAS  PubMed  PubMed Central  Google Scholar  * Song Q, Liu X, Wang X, Wu S. Age-

and gender-specific associations between sleep duration and incident hypertension in a Chinese population: the Kailuan study. J Hum Hypertens. 2016;30:503. Article  CAS  PubMed  Google

Scholar  * Williams MA, Miller RS, Qiu C, Cripe SM, Gelaye B, Enquobahrie D. Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders

in pregnancy. Sleep. 2010;33:1363–71. Article  PubMed  PubMed Central  Google Scholar  * Wu X, Sun Y, Niu K, Wei Y, Bo B, Yu X, et al. Association of self-reported sleep duration and

hypertension: Results of a Chinese prospective cohort study. Clin Exp Hypertens. 2016;38:1514–9. Article  PubMed  Google Scholar  * Yadav D, Hyun DS, Ahn SV, Koh SB, Kim JY. A prospective

study of the association between total sleep duration and incident hypertension. J Clin Hypertens. 2017;19:1550–7. Article  PubMed  PubMed Central  Google Scholar  * Gangwischm JE, Malaspina

D, Posner K, Babiss LA, Heymsfield SB, Turner JB, et al. Insomnia and sleep duration as mediators of the relationship between depression and hypertension incidence. Am J Hypertens.

2010;23:62. Article  Google Scholar  * Friedman O, Bradley TD, Ruttanaumpawan P, Logan AG. Independent association of drug-resistant hypertension to reduced sleep duration and efficiency. Am

J Hypertens. 2010;23:174. Article  PubMed  Google Scholar  * Gangwisch JE, Feskanich D, Malaspina D, Shen S, Forman JP. Sleep duration and risk for hypertension in women: results from the

nurses’ health study. Am J Hypertens. 2013;26:903–11. Article  CAS  PubMed  PubMed Central  Google Scholar  * Kuciene R, Dulskiene V. Associations of short sleep duration with

prehypertension and hypertension among Lithuanian children and adolescents: a cross-sectional study. BMC Public Health. 2014;14:1–8. Article  Google Scholar  * Guo X, Zheng L, Li Y, Yu S,

Liu S, Zhou X, et al. Association between sleep duration and hypertension among Chinese children and adolescents. Clin Cardiol. 2011;34:774–81. Article  PubMed  PubMed Central  Google

Scholar  * Gangwisch JE. A review of evidence for the link between sleep duration and hypertension. Am J Hypertens. 2014;27:1235. Article  CAS  PubMed  PubMed Central  Google Scholar  *

Bruno RM, Palagini L, Gemignani A, Virdis A, Di GA, Ghiadoni L, et al. Poor sleep quality and resistant hypertension. Sleep Med. 2013;14:1157. Article  PubMed  Google Scholar  * Pascaline P,

Le VM, Nicole M, Audrey P, Thierry P, Xuan-Lan N, et al. Cumulative association of obstructive sleep apnea severity and short sleep duration with the risk for hypertension. PLoS ONE.

2014;9:e115666. Article  Google Scholar  Download references AUTHOR INFORMATION Author notes * These authors contributed equally: Hui Li, Yu Ren AUTHORS AND AFFILIATIONS * Cardiology

Department, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous, Region, 010017, China Hui Li, Yun Wu & Xingsheng Zhao * Clinical Medical Research Center, Inner Mongolia

People’s Hospital, Hohhot, Inner Mongolia Autonomous, Region, 010017, China Yu Ren Authors * Hui Li View author publications You can also search for this author inPubMed Google Scholar * Yu

Ren View author publications You can also search for this author inPubMed Google Scholar * Yun Wu View author publications You can also search for this author inPubMed Google Scholar *

Xingsheng Zhao View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Xingsheng Zhao. ETHICS DECLARATIONS CONFLICT OF

INTEREST The authors declare that they have no conflict of interest. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Li, H., Ren, Y., Wu, Y. _et al._

Correlation between sleep duration and hypertension: a dose-response meta-analysis. _J Hum Hypertens_ 33, 218–228 (2019). https://doi.org/10.1038/s41371-018-0135-1 Download citation *

Received: 28 June 2018 * Revised: 25 October 2018 * Accepted: 30 October 2018 * Published: 19 November 2018 * Issue Date: March 2019 * DOI: https://doi.org/10.1038/s41371-018-0135-1 SHARE

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