Gender differences in sleep quality and its associated factors in patients with hypertension: a cross-sectional study

In Malaysia, one third of the adult population suffer from hypertension and literature reported poor sleep quality led to cardiovascular events. However, little study was conducted to look at the gender-specific differences in sleep quality among hypertensive patients. This study aimed to examine gender difference in sleep quality and its associated factors among hypertensive population in a primary care clinic.

This was a cross-sectional study conducted from December 2023 to February 2024 using systematic approach with validated questionnaires (PSQI, DASS-21, STOP-BANG). Multiple logistic regression and Firth's penalized regression (to address sparse data/complete separation) were used to identify the determinants of poor sleep among different gender hypertensive patients.

Three hundred thirty-five participants (62.9% female, mean age 58 years) were recruited in this study. Prevalence of poor sleep among male and female were 91.1% and 84.8% respectively. In the multivariable analysis for men, a lack of regular physical exercise (< 150 min/week) was identified as the sole significant predictor of poor sleep (aOR 6.278, p = 0.040). Among women, poor sleep was significantly associated with anxiety symptoms (aOR 11.486; 95% CI: 1.37-96.21; p = 0.024) and income, where those in the B40 (bottom 40% income) and T20 (top 20% income) groups had higher odds of poor sleep compared to the M40 group (aOR 3.46; 95% CI: 1.23-9.72; p = 0.019).

These findings highlight gender-specific determinants of sleep disturbances among those with hypertension, suggesting tailored interventions addressing physical inactivity for men and socioeconomic support or anxiety management for women to improve sleep quality.