Longer Sleep Duration is Associated With Lower BP Among Pediatric Patients

A shorter sleep duration and late sleep onset may affect the risk for hypertension in children, according to the findings of a study published in Pediatrics. 

Approximately 6% of children in the United States have hypertension. While lifestyle modifications are recommended for children with hypertension, sleep promotion tends to be overlooked.

Researchers conducted a retrospective study to evaluate the impact of sleep on blood pressure (BP) markers in a pediatric population. Participants were pediatric patients referred to the Children’s Hospital of Philadelphia (CHOP) nephrology clinic for elevated BP assessment and ambulatory BP monitoring (ABPM) from January 2015 through December 2020.

Children younger than 5 years old do not typically undergo ABPM. Some exclusion criteria were patients with chronic medical conditions with a duration or expected duration that exceeds 3 months treated by medications and medications that could impact BP. Patients with obesity, premature birth, and mental health diagnoses were permitted for inclusion in this study. 

Hypertension was diagnosed according to the 2022 update of the American Heart Association’s Ambulatory Blood Pressure Monitoring in Children and Adolescents guide. The adult hypertension threshold of 130/80 mmHg was used when the patient fell within the 95th percentile for sex and weight and had a BP greater than or equal to 130/88 mmHg while awake or 110/65 mmHg when sleeping. Researchers defined nocturnal dipping as a 10% or lower average sleep BP compared to the average BP while awake. Sleep duration was self-reported and researchers used the American Academy of Sleep Medicine age-specific cutoffs to classify duration.

A total of 1571 patients were screened for inclusion and 539 (mean age, 14.6 years; female, 39%; White, 49%) were included in the final analysis. Approximately one-third of the sample (33%) were classified as obesity and over half (56%) met the hypertension criteria. 

The average sleep duration was 9.1 hours per night, with an average sleep onset time of 11:06 PM and an average sleep offset of 8:18 AM. 

The linear regression analysis revealed that longer sleep duration was linked to improved daytime BP parameters. Every additional hour of sleep was linked to a lower wake systolic BP index (β, -0.08; 95% CI, -0.13 to -0.02). Additionally, each additional hour of sleep was associated with decreased wake hypertension (odds ratio [OR], 0.88; 95% CI, 0.79-0.99) and reduced wake systolic hypertension (OR, 0.87; 95% CI, 0.77-0.98) 

Patients reporting later sleep onset experienced worse daytime BP parameters. Every additional hour of a later sleep onset was linked to a higher wake systolic BP index (β, 0.07; 95% CI, 0.02-0.13) and wake diastolic BP index (β, 0.07; 95% CI, 0.02-0.12). 

Study limitations included self-reported sleep times, the lack of accounting for sleep-disordered breathing, and the retrospective nature of this study. 

“Shorter sleep and later sleep onset may affect BP through disruption of circadian rhythm and autonomic imbalance, such as elevated sympathetic nervous system activity and decreased parasympathetic activity during sleep,” the researchers concluded.