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      Sleep and hypertension

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          Abstract

          Purpose

          Hypertension is a global public issue, and sleep status was regarded as its risk factor; however, the results were inconsistent. This study aims to deeply investigate the correlation between sleep status and hypertension.

          Methods

          The electronic databases Cochrane Library, Pubmed, and Embase updated to May 31, 2019, were retrieved. Studies were selected according to the predefined screening criteria, and their qualities were assessed by using quality check scales. Based on Stata 15.1 software, the associations between sleep status and hypertension were analyzed by meta-analyses, using odds ratio and 95% confidence interval as effect indexes. Furthermore, publication bias and small study bias were evaluated using Begg and Egger’s test. In addition, sensitivity analysis was conducted through ignoring one study per time and then observing its influences on the pooled results.

          Results

          A total of 54 studies (involving 1,074,207 subjects) were eligible for this meta-analysis. Six factors were included in this study. Raised blood pressure was associated with obstructive sleep apnea (OSA), oxygen desaturation index (ODI), short sleep duration, and long sleep duration. The differences in ≤ 5 h, 6 h, ≥ 9 h, and 10 h groups had statistical significances, while there was no significant difference in ≥ 8 h group. Snoring is a risk factor of hypertension (OR = 1.94, 95%CI 1.41–2.67). Subgroup analysis was conducted and results were varied.

          Conclusions

          The hypertension risk might be reduced by treated OSA, ODI, and snoring, as well as appropriate sleep duration. More studies with large sample sizes and high qualities should be included to support the findings further.

          Electronic supplementary material

          The online version of this article (10.1007/s11325-019-01907-2) contains supplementary material, which is available to authorized users.

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          Most cited references15

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          Sleep and hypertension.

          Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.
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            Short sleep duration and increased risk of hypertension: a primary care medicine investigation.

            Compelling evidence from laboratory-based and population-based studies link sleep loss to negative cardiovascular health outcomes. However, little is known about the association between sleep duration and hypertension in primary care health settings, independently of other well controlled clinical and biochemical characteristics. We investigated the association between sleep duration and the prevalence of hypertension adjusting for 21 potential confounding factors in a noncontrolled primary care sample. The sample included 1046 French adults older than 40 years (mean age, 55.5 years), who visited any of the general practitioners of primary care centers in the Paris area. Blood pressure (BP) readings, blood samples and standardized health and sleep questionnaires were performed on each participant. Hypertension inclusion criteria were either high BP measurements (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) or the use of antihypertensive medications. Sleep duration was recorded as the self-reported average number of hours of sleep per night during the week. Logistic regressions were performed to test the association between hypertension and sleep duration adjusted for sociodemographic, clinical, biochemical, lifestyle, psychological and sleep disorder covariates. Compared to the group sleeping 7 h, individuals sleeping 5 h or less had an increased odds ratio (OR) for the prevalence of hypertension [OR = 1.80, 95% confidence interval (1.06-3.05)], after adjusting for 21 potential confounders which did not markedly attenuate this association. Our data provide further epidemiologic evidence that with no specific selection in primary care medicine, usual short-sleep duration increases the risk of hypertension prevalence in adults over 40 years.
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              Obstructive sleep apnea and hypertension.

              Obstructive sleep apnea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure. However, these studies do indicate a wide variation in the blood pressure effects of CPAP, with some patients, on an individual basis, manifesting a large antihypertensive benefit. OSA is particularly common in patients with resistant hypertension. The reason for this high prevalence of OSA is not fully explained, but data from our laboratory suggest that it may be related to the high occurrence of hyperaldosteronism in patients with resistant hypertension. We hypothesize that aldosterone excess worsens OSA by promoting accumulation of fluid in the neck, which then contributes to increased upper airway resistance.
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                Author and article information

                Contributors
                zengyun856@163.com
                Journal
                Sleep Breath
                Sleep Breath
                Sleep & Breathing = Schlaf & Atmung
                Springer International Publishing (Cham )
                1520-9512
                1522-1709
                12 August 2019
                12 August 2019
                2020
                : 24
                : 1
                : 351-356
                Affiliations
                [1 ]GRID grid.413856.d, ISNI 0000 0004 1799 3643, Department of Preventive Medicine, , Chengdu Medical College, ; Chengdu, China
                [2 ]GRID grid.413856.d, ISNI 0000 0004 1799 3643, Department of Epidemiology and Statistics, , Chengdu Medical College, ; Chengdu, China
                [3 ]GRID grid.413856.d, ISNI 0000 0004 1799 3643, School of Public Health, , Chengdu Medical College, ; Chengdu, China
                Author information
                http://orcid.org/0000-0003-0734-0035
                Article
                1907
                10.1007/s11325-019-01907-2
                7127991
                31402441
                5d15904e-4ef1-410c-af9c-14dcb47e721f
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 4 May 2019
                : 28 June 2019
                : 23 July 2019
                Funding
                Funded by: education department of Sichuan Province
                Award ID: 16ZA0281
                Award Recipient :
                Funded by: Collaborative innovation center of elderly care and health
                Award ID: YLZBZ1818
                Award Recipient :
                Categories
                Epidemiology • Original Article
                Custom metadata
                © Springer Nature Switzerland AG 2020

                Medicine
                sleep,hypertension,obstructive sleep apnea,snoring
                Medicine
                sleep, hypertension, obstructive sleep apnea, snoring

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