Abstract Body: Introduction: Several studies have examined the association between insomnia and short sleep duration with elevated blood pressure (eBP) and stage 2 hypertension (HTN) in middle-aged adults. However, no study to date has examined the joint effect of self-reported insomnia and objective short sleep on eBP and HTN in adolescents.
Methods: 421 adolescents (16.5±2.3 years old, 53.9% male, 21.9% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample, underwent 9-hour polysomnography (PSG) and physical examinations. Insomnia was defined by a self-report of difficulties falling and/or staying asleep, while objective short sleep duration was defined based on the median PSG-measured total sleep time (i.e., < 7.7 hours of sleep). BP levels were measured 3 consecutive times in the seated position and the average of the last 2 was used to ascertain the presence of eBP (i.e., systolic ≥120 and diastolic <80 mmHg) and HTN (i.e., systolic ≥140 or diastolic ≥90 mmHg). Logistic regression models assessed the association of each group based on insomnia and objective sleep duration with eBP and HTN, while adjusting for age, sex, race/ethnicity, body mass index, apnea/hypopnea index, periodic limb movement index, socioeconomic status, and working status.
Results: Compared to the reference group (n=126), adolescents who reported insomnia and slept objectively short (n=77) had 5-fold odds (95%CI=1.1-23.0, p-value=0.041) of having HTN. Adolescents who did not report insomnia but slept objectively short (n=136) had 2.7-fold odds (95%CI=1.5-4.8, p-value=0.001) of having eBP. Adolescents who reported insomnia and slept objectively normal (n=82) did not show any significant associations with either eBP or HTN.
Conclusions: Insomnia with objective short sleep duration in adolescents is associated with stage 2 HTN, while short sleep alone is associated with incipient eBP. These findings further support that insomnia with short sleep duration is a more biologically severe phenotype of the disorder requiring different therapeutic approaches to improve sleep and reduce cardiovascular risk.