Snoring, Excessive Daytime Sleepiness Linked With Increased Risk for Hypertension

An increased risk of developing hypertension is linked with self-reported snoring and excessive daytime sleepiness, according to study findings published in Hypertension.

Investigators explored the possibility that snoring and sleepiness are associated with incident hypertension.

The investigators conducted a prospective study using data from the French population-based CONSTANCES cohort. Between 2012 and 2016, normotensive adult individuals aged 18 to 69 years were screened for morning fatigue, daytime sleepiness, and snoring and subsequently completed the 2017 follow-up using the Berlin Questionnaire.

Cox models adjusted for sleep duration (6-7 hours [h], 24.8%; 7-8 h, 42.1%; 8-9h, 21.1%), baseline blood pressure (BP; optimal, 40.1%; normal, 33.9%; high-normal, 26.0%), body mass index (BMI; 18-25, 65.2%; 25-30, 25.6%), and depressive symptoms (14.3%) were used to compute adjusted hazard ratios (aHRs) of incidentally treated hypertension. Briefly, CONSTANCES included more than 200,000 volunteers covered by the French general insurance scheme which involves about 85% of the French population. Individuals with heart failure, myocardial infarction, stroke, or history of sleep apnea were excluded.

Overall, 34,727 individuals (30.9% <40 years of age; 19.4% ≥60 years of age; 41.6% men) were included in analyses with self-reported prevalence of morning fatigue (16.6%), excessive daytime sleepiness (19.1%), and habitual snoring (23.6%; minimum 3x/week for each condition/behavior). The incidence of treated hypertension was 4.1% across median follow-up of 3.1 years (IQR, 3.0-3.5).

The investigators noted a higher risk for de novo treated hypertension among individuals who reported excessive daytime sleepiness (aHR, 1.42; 95% CI, 1.24-1.62) and habitual snoring (aHR, 1.17; 95% CI, 1.03-1.32), which increased with the weekly frequency of symptoms in a dose-dependent relationship (P_trend ≤.02 for all symptoms).

Compared with individuals who remained normotensive, those who developed hypertension were older women with lower education levels and likely either no or high alcohol consumption and extreme sleep duration (<6 h or >8h), as well as higher BMI, baseline BP, and more symptoms of depression. Compared with occasional- or non-snorers, habitual snorers were older men with lower education levels and likely living with a partner. Compared with individuals without sleepiness, those with frequent sleepiness were younger women with lower education who lived alone and were more often smokers.

Study limitations include BP not being measured during follow-up and only pharmacologically treated hypertension being recognized, relatively short follow-up time, and the covariates of sleep duration and symptoms of depression were not analyzed in the same questionnaire as snoring and sleepiness.

“Self-reported snoring and excessive daytime sleepiness are associated with an increased risk of developing hypertension,” the investigators concluded. “These associations were found to be dose-dependent, independent of multiple potential confounders, including BMI, baseline BP, sleep duration, and symptoms of depression, and were significant when symptoms were present alone or combined.”

Disclosure: This research (CONSTANCES) was supported by AstraZeneca, Lundbeck, L’Oréal, and Merck Sharp and Dohme Corp. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor