We aimed to investigate the association of self-reported nighttime sleep duration and daytime napping duration with hypertension in rural areas of China. The participants, who were from rural areas of Hunan Province in China, were enrolled during 2016–2017. Nighttime sleep duration (<7 h, 7–8 h, and ≥9 h) and daytime napping duration(no nap, 0-1 h, and >1 h) were determined by a self-reported questionnaire. Hypertension was defined as a mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg or a self-reported physician diagnosis of hypertension and current use of antihypertensive medication. Of 1763 enrolled participants, 52% had hypertension. A total of 640 (36%) were male and 1123 (64%) were female; the mean age was 56 years. After adjusting for potential confounders, participants who slept for ≥9 h per night had a 1.29-fold (95% CI: 1.03, 1.60) increased odds of hypertension compared to the reference group (7–8 h per night). Daytime napping >1 h was negatively associated with hypertension, with an adjusted OR (95% CI) of 0.70 (0.51, 0.97), and the protective effect of longer daytime napping was still found in the subgroup sleeping 7–8 h per night. Among the rural population in China, long nighttime sleep duration is associated with a higher prevalence of hypertension, and longer daytime napping is related to a decreased prevalence of hypertension.
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GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.
Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, et al. Status of hypertension in China: results from the China hypertension survey, 2012–2015. Circulation. 2018;137:2344–56.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.
Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006;29:1009–14.
Fang J, Wheaton AG, Keenan NL, Greenlund KJ, Perry GS, Croft JB. Association of sleep duration and hypertension among US adults varies by age and sex. Am J Hypertens. 2012;25:335–41.
Wu W, Wang W, Gu Y, Xie Y, Liu X, Chen X, et al. Sleep quality, sleep duration, and their association with hypertension prevalence among low-income oldest-old in a rural area of China: a population-based study. J Psychosom Res. 2019;127:e109848.
Feng X, Liu Q, Li Y, Zhao F, Chang H, Lyu J. Longitudinal study of the relationship between sleep duration and hypertension in Chinese adult residents (CHNS 2004-2011). Sleep Med. 2019;58:88–92.
Li M, Yan S, Jiang S, Ma X, Gao T, Li B. Relationship between sleep duration and hypertension in northeast China: a cross-sectional study. BMJ Open. 2019;9:e023916.
Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, et al. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006;47:833–9.
Zhang H, Zhao X, Li Y, Mao Z, Huo W, Jiang J, et al. Night sleep duration and sleep initiation time with hypertension in Chinese rural population: the Henan Rural Cohort. Eur J Public Health. 2020;30:164–70.
Cao Z, Shen L, Wu J, Yang H, Fang W, Chen W, et al. The effects of midday nap duration on the risk of hypertension in a middle-aged and older Chinese population: a preliminary evidence from the Tongji-Dongfeng Cohort Study, China. J Hypertens. 2014;32:1993–8.
Lenfant C, Chobanian AV, Jones DW, Roccella EJ. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Hypertension. 2003;41:1178–9.
Grandner M, Mullington JM, Hashmi SD, Redeker NS, Watson NF, Morgenthaler TI. Sleep duration and hypertension: analysis of >700,000 adults by age and sex. J Clin Sleep Med. 2018;14:1031–9.
Thorpy M. Association of sleep duration with hypertension. Curr Neurol Neurosci Rep. 2007;7:159–60.
Wang T, Lu J, Wang W, Mu Y, Zhao J, Liu C, et al. Sleep duration and snoring associate with hypertension and glycaemic control in patients with diabetes. Diabet Med. 2015;32:1001–7.
Guo X, Zheng L, Wang J, Zhang X, Zhang X, Li J, et al. Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med. 2013;14:324–32.
Zhang H, Li Y, Mao Z, Liu M, Huo W, Liu R, et al. A dose-response association of night sleep duration with hypertension in a Chinese rural population: the Henan Rural Cohort Study. J Am Soc Hypertens. 2018;12:867–79.
Guo J, Fei Y, Li J, Zhang L, Luo Q, Chen G. Gender- and age-specific associations between sleep duration and prevalent hypertension in middle-aged and elderly Chinese: a cross-sectional study from CHARLS 2011-2012. BMJ Open. 2016;6:e011770.
Wang H, Zee P, Reid K, Chervin RD, Patwari PP, Wang B, et al. Gender-specific association of sleep duration with blood pressure in rural Chinese adults. Sleep Med. 2011;12:693–9.
Suzuki E, Yorifuji T, Ueshima K, Takao S, Sugiyama M, Ohta T, et al. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. Prev Med. 2009;49:135–41.
Watson NF, Harden KP, Buchwald D, Vitiello MV, Pack AI, Strachan E, et al. Sleep duration and depressive symptoms: a gene-environment interaction. Sleep. 2014;37:351–8.
Van Ryswyk E, Mukherjee S, Chai-Coetzer CL, Vakulin A, McEvoy RD. Sleep disorders, including sleep apnea and hypertension. Am J Hypertens. 2018;31:857–64.
Guan Y, Zhang M, Zhang X, Zhao Z, Huang Z, Li C, et al. Association between sleep duration and hypertension of migrant workers in China: a national cross-sectional surveillance study. BMJ Open. 2019;9:e031126.
Lu K, Chen J, Wu S, Chen J, Hu D. Interaction of sleep duration and sleep quality on hypertension prevalence in adult Chinese males. J Epidemiol. 2015;25:415–22.
Wang D, Zhou Y, Guo Y, Zhang R, Li W, He M, et al. The effect of sleep duration and sleep quality on hypertension in middle-aged and older Chinese: the Dongfeng-Tongji Cohort Study. Sleep Med. 2017;40:78–83.
Najafian J, Nouri F, Mohammadifard N. Association between sleep duration and hypertension: Isfahan Healthy Heart Program. Iran ARYA Atherosclerosis. 2019;15:22–6.
Faraut B, Touchette E, Gamble H, Royant-Parola S, Safar ME, Varsat B. et al. Short sleep duration and increased risk of hypertension: a primary care medicine investigation. J Hypertens. 2012;30:1354–63.
Yadav D, Hyun DS, Ahn SV, Koh SB, Kim JY. A prospective study of the association between total sleep duration and incident hypertension. J Clin Hypertens. 2017;19:550–7.
Kim J, Jo I. Age-dependent association between sleep duration and hypertension in the adult Korean population. Am J Hypertens. 2010;23:1286–91.
Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009;32:491–7.
Knutson KL, Van Cauter E, Rathouz PJ, Yan LL, Hulley SB, Liu K, et al. Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med. 2009;169:1055–61.
Li H, Ren Y, Wu Y, Zhao X. Correlation between sleep duration and hypertension: a dose-response meta-analysis. J Hum Hypertens. 2019;33:218–28.
Wang Q, Xi B, Liu M, Zhang Y, Fu M. Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res. 2012;35:1012–8.
Burazeri G, Gofin J, Kark JD. Siesta and mortality in a Mediterranean population: a community study in Jerusalem. Sleep. 2003;26:578–84.
Naska A, Oikonomou E, Trichopoulou A, Psaltopoulou T, Trichopoulos D. Siesta in healthy adults and coronary mortality in the general population. Arch Intern Med. 2007;167:296–301.
Lucassen EA. To nap or not to nap: is the Wujiao a healthy habit? Sleep Med. 2013;14:929–30.
Brindle RC, Conklin SM. Daytime sleep accelerates cardiovascular recovery after psychological stress. Int J Behav Med. 2012;19:111–4.
Cai M, Huang Y, Sun X, He Y, Sun C. Siesta is associated with reduced systolic blood pressure level and decreased prevalence of hypertension in older adults. J Hum Hypertens. 2016;30:216–8.
Zhao H, Gui W, Huang H, Liu Y, Ding H, Fan W, et al. Association of long-term sleep habits and hypertension: a cross-sectional study in Chinese adults. J Hum Hypertens. 2019;53:121–30.
Yang Y, Liu W, Ji X, Ma C, Wang X, Li K, et al. Extended afternoon naps are associated with hypertension in women but not in men. Heart Lung. 2020;49:2–9.
Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: how similar are they? Epidemiology. 2008;19:838–45.
We thank all the participants and all coordinators and investigators who contributed to the field survey.
This study was supported by the Ministry of Science and Technology of China (2015FY111100) and the National Key Research and Development Project of China (2018YFC1311302, 2019YFF0216300).
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The authors declare that they have no conflict of interest.
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Huang, M., Yang, Y., Huang, Z. et al. The association of nighttime sleep duration and daytime napping duration with hypertension in Chinese rural areas: a population-based study. J Hum Hypertens 35, 896–902 (2021). https://doi.org/10.1038/s41371-020-00419-x