Sleep status and hypertension: a risk assessment
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EPIDEMIOLOGY • LETTER TO THE EDITORS
Sleep status and hypertension: a risk assessment Tomoyuki Kawada 1 Received: 20 July 2020 / Revised: 20 July 2020 / Accepted: 16 September 2020 # Springer Nature Switzerland AG 2020
Dear Editor, I have read with interest a meta-analysis by Han et al. concerning the association of sleep status with hypertension [1]. The odds ratio (OR) (95% confidence interval [CI]) of snoring for hypertension was 1.94 (1.41–2.67). In addition, the OR of short and long sleep duration for hypertension by setting 7–8 h as a control group presented a significant increase, although different study designs have presented different levels of significance. I have some queries about their study. First, Zhao et al. conducted a prospective observational study to investigate the association of sleep with the risk of hypertension [2]. Compared to the subjects who slept 7–8 h, the ORs (95% CIs) of subjects with sleep duration 6–7 h, 8–9 h, and over 9 h for the prevalence of hypertension were 1.42 (1.01–2.00), 1.60 (1.07–2.40), and 2.39 (1.60–3.58), respectively. In addition, the OR (95% CI) of habitual daytime napping for hypertension was 0.80 (0.62–0.97). They concluded that there was a positive association of both short and long sleep duration with hypertension, and habitual daytime napping lowered the risk of hypertension. Han et al. presented no significant association in cohort studies except sleep duration ≤ 7 h, and I suppose that different categories of sleep duration might be related to study outcomes. Zhao et al. categorized sleep duration as follows: < 6 h, 6–7 h, 7–8 h, 8–9 h, and > 9 h [2]. It is unclear in which category someone would be placed if they slept exactly 7 or 8 h. If they slept 7 h, would they be placed in the 6–7 h category or the 7–8 h category? Caution should be paid especially when conducting a meta-analysis. Second, Wang et al. conducted a meta-analysis on the association between sleep duration and hypertension [3]. Risk ratio (RR) (95% CI) of short sleep duration for incident hypertension was 1.161 (1.058–1.274). In contrast, RR (95% CI)
of sleep duration ≥ 8 h for incident hypertension was 1.059 (0.951–1.180). There was no risk of long sleep duration for hypertension, which was inconsistent with data by Han et al. and Zhao et al., respectively [1, 2]. Third, Li et al. conducted a cross-sectional study to investigate the relationship between body fat percentage (BFP) and hypertension [4]. Adjusted ORs (95% CIs) of the highest BFP quartile against the lowest for hypertension were 3.30 (2.85– 3.83) in men and 2.66 (2.36–2.99) in women. The adjusted ORs increased along with increasing BFP levels. They concluded that BFP was significantly associated with hypertension in both men and women. This report presented the significance of obesity for the risk of hypertension. As sleep parameters are closely related to obesity, the interrelationship among sleep, obesity, and hypertension with special reference to sex should be specified. Finally, there is a significant association betwee
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