Sleep-disordered breathing, sleep duration, and 24-hour ambulatory blood pressure in subjective short-sleeping adults

Obstructive sleep apnea (OSA) and short sleep duration each contribute to hypertension risk, yet their combined influence on 24-h blood pressure patterns remains poorly characterized. This study evaluated associations between sleep apnea severity (apnea-hypopnea index, AHI), objective sleep duration, and ambulatory blood pressure (ABP).

This cross-sectional secondary analysis used data from a behavioral sleep extension trial which included adults with self-reported sleep duration <7 h and elevated in-office blood pressure. Wrist-worn actigraphy measured objective sleep duration, a single-night home sleep apnea test assessed OSA severity, and participants completed 24-h ABP monitoring. Linear regression evaluated associations between AHI and mean systolic/diastolic blood pressure (DBP); logistic models examined AHI associations with systolic/diastolic non-dipping.

Of 195 participants with valid data, each 10-event/hour higher AHI was associated with higher mean DBP in both the unadjusted model (0.96 mmHg [95% CI 0.20, 1.71]; p = 0.013) and the adjusted model (0.92 mmHg [95% CI 0.10, 1.73]; p = 0.027). For systolic non-dipping, the unadjusted model showed higher odds with higher AHI (OR per 10-event/hour higher AHI 1.34; 95% CI 1.00 to 1.82; p = 0.049). After adjustment for age, sex, race, and BMI, the estimate was similar in direction but did not meet statistical significance (OR 1.35; 95% CI 0.97 to 1.97; p = 0.090). The AHI × sleep duration interaction for systolic non-dipping had p = 0.045.

Among adults with elevated in-office blood pressure and short sleep duration, greater OSA severity predicted higher mean DBP.