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Prevalence of poor sleep quality and its associated factors among hypertensive patients on follow up at Jimma University Medical Center


Several studies have reported an association between the abnormal duration of sleep and chronic conditions including hypertension. However, the existing body of evidence is not entirely significant; as insignificant associations between poor sleep and blood pressure (BP) have been found across different studies. The aim of this study was to determine prevalence and factors associated with poor sleep quality among hypertensive patients in Jimma University Medical Center. An institution based cross sectional study design was employed from June 01 to July 15, 2018 among 279 hypertensive patients on follow-up at Jimma University Medical Centre chronic clinic, Jimma, Ethiopia. Data collection was done by using face to face interview. Sleep quality was measured by using validated, standard Pittsburgh sleep quality index (PSQI). PSQI total score ≥5 was considered as a diagnostic of poor sleep quality. On multivariate logistic regression variables with of p value of <0.05 was considered as predictors of poor sleep quality. A total of 279 hypertensive patients were enrolled into the study. Out of which 279, 142 (50.9%) were males. The prevalence of poor sleep quality among hypertensive patient was 99 (35.5%). Physical inactivity (AOR = 0.288, 95% CI: (0.130–0.639), diastolic blood pressure Stage I (AOR = 3.923, 95% CI: 1.052–14.632) and diastolic blood pressure Stage II (AOR = 4.520; 95% CI: 1.079–18.931) were identified as independent predictors of poor sleep quality. In conclusion, about one-third of hypertensive patients were poor sleepers. High diastolic blood pressure and physical inactivity are independent predictors of poor sleep quality among hypertensive patients.

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  1. 1.

    Dikeos D, Georgantopoulos G. Medical comorbidity of sleep disorders. Curr Opin Psychiatry. 2011;24:346–54.

    Article  Google Scholar 

  2. 2.

    Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Chatterji S, Leonardi M, et al. Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study. PloS ONE. 2014;9:e114742.

    Article  Google Scholar 

  3. 3.

    Altevogt BM, Colten HR. Sleep disorders and sleep deprivation: an unmet public health problem. National Academies Press; 2006.

  4. 4.

    Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, et al. A prospective study of sleep duration and coronary heart disease in women. Arch. Intern. Med. 2003;163:205–9.

    Article  Google Scholar 

  5. 5.

    Cappuccio FP, Stranges S, Kandala N-B, Miller MA, Taggart FM, Kumari M, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. Hypertension. 2007;50:693–700.

    CAS  Article  Google Scholar 

  6. 6.

    Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep. 2011;34:1487–92.

    Article  Google Scholar 

  7. 7.

    Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc Sci Med. 2010;71:1027–36.

    Article  Google Scholar 

  8. 8.

    Huang Y, Mai W, Hu Y, Wu Y, Song Y, Qiu R, et al. Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension. Blood Press Monit. 2011;16:117–23.

    Article  Google Scholar 

  9. 9.

    Calhoun DA, Harding SM. Sleep and hypertension. Chest. 2010;138:434–43.

    Article  Google Scholar 

  10. 10.

    Fung MM, Peters K, Redline S, Ziegler MG, Ancoli-Israel S, Barrett-Connor E, et al. Decreased slow wave sleep increases risk of developing hypertension in elderly men. Hypertension. 2011;58:596–603.

    CAS  Article  Google Scholar 

  11. 11.

    Kales A, Cadieux R, Shaw L, Vela-Bueno A, Bixler E, Schneck D, et al. Sleep apnoea in a hypertensive population. Lancet. 1984;324:1005–8.

    Article  Google Scholar 

  12. 12.

    Liu R-Q, Qian Z, Trevathan E, Chang J-J, Zelicoff A, Hao Y-T, et al. Poor sleep quality associated with high risk of hypertension and elevated blood pressure in China: results from a large population-based study. Hypertens Res. 2016;39:54.

    Article  Google Scholar 

  13. 13.

    Ohkubo T, Hozawa A, Nagaie K, Kikuya M, Tsujia I, Itoc S, et al. Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population: the Ohasama study. J Hypertens. 2000;18:847–54.

    CAS  Article  Google Scholar 

  14. 14.

    Chattu VK, Sakhamuri SM, Kumar R, Spence DW, BaHammam AS, Pandi-Perumal SR. Insufficient Sleep Syndrome: Is it time to classify it as a major noncommunicable disease? Sleep Sci. 2018;11:56.

    Article  Google Scholar 

  15. 15.

    Bansil P, Kuklina EV, Merritt RK, Yoon PW. Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008. J Clin Hypertens. 2011;13:739–43.

    Article  Google Scholar 

  16. 16.

    Sekercioglu N, Curtis B, Murphy S, Barrett B. Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design. Ren Fail. 2015;37:757–62.

    Article  Google Scholar 

  17. 17.

    Salahuddin M, Maru TT, Kumalo A, Pandi-Perumal SR, Bahammam AS, Manzar MD. Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults. Health Qual Life Outcomes. 2017;15:58.

    Article  Google Scholar 

  18. 18.

    Alebiosu OC, Ogunsemi OO, Familoni OB, Adebayo PB, Ayodele OE. Quality of sleep among hypertensive patients in a semi-urban Nigerian community: a prospective study. Postgrad Med. 2009;121:166–72.

    Article  Google Scholar 

  19. 19.

    Hanus JS, Amboni G, Rosa MI, da, Ceretta LB, Tuon L. The quality and characteristics of sleep of hypertensive patients. Rev Esc Enferm USP. 2015;49:0596–602.

    Article  Google Scholar 

  20. 20.

    Tavasoli A, Saeidi M, Hooman N. Correlation between sleep quality and blood pressure changes in Iranian children. J Compr Pediatr. 2015;6.

  21. 21.

    Mossie A, Kindu D, Negash A. Prevalence and severity of depression and its association with substance Use in Jimma Town, Southwest Ethiopia. Depress Res Treat. 2016;2016:3460462.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Damena T, Mossie A, Tesfaye M. Khat chewing and mental distress: a community based study, in jimma city, southwestern ethiopia. Ethiop J Health Sci. 2011;21:37–46.

    Article  Google Scholar 

  23. 23.

    Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in Jimma town, Southwest Ethiopia: a community-based cross-sectional study. Sleep Disord. 2018;2018:8342328.

    Article  Google Scholar 

  24. 24.

    Al-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research. J Ethnopharmacol. 2010;132:540–8.

    CAS  Article  Google Scholar 

  25. 25.

    Patel NB. Mechanism of action of cathinone: the active ingredient of Khat (Catha Edulis). East Afr Med J. 2000;77.

  26. 26.

    Monti JM, Monti D. The involvement of dopamine in the modulation of sleep and waking. Sleep Med Rev. 2007;11:113–33.

    Article  Google Scholar 

  27. 27.

    Kline CE. The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2014;8:375–9.

    Article  Google Scholar 

  28. 28.

    Štefan L, Sporiš G, Krističević T, Knjaz D. Associations between sleep quality and its domains and insufficient physical activity in a large sample of Croatian young adults: a cross-sectional study. BMJ Open. 2018;8:e021902.

    Article  Google Scholar 

  29. 29.

    Kadoya M, Koyama H, Kurajoh M, Naka M, Miyoshi A, Kanzaki A, et al. Associations of sleep quality and awake physical activity with fluctuations in nocturnal blood pressure in patients with cardiovascular risk factors. PloS ONE. 2016;11:e0155116.

    Article  Google Scholar 

  30. 30.

    Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011;34:1631–40.

    Article  Google Scholar 

  31. 31.

    Andrade FMD, de, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. J Bras Pneumol. 2016;42:457–64.

    Article  Google Scholar 

  32. 32.

    Lo K, Woo B, Wong M, Tam W. Subjective sleep quality, blood pressure, and hypertension: a meta-analysis. J Clin Hypertens. 2018;20:592–605.

    Article  Google Scholar 

  33. 33.

    Smulyan H, Safar ME. The diastolic blood pressure in systolic hypertension. Ann Intern Med. 2000;132:233–7.

    CAS  Article  Google Scholar 

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First of all, we would like to praise our God, without his help all this would have been impossible. Also, we don’t want to pass without acknowledging data collectors and study participants. We want to express appreciation to our colleagues for their continuous encouragement. Lastly, we would like to thank Jimma University Medical Center for any facilitation during the study period.


This research was funded by Institute of Health Sciences, Jimma University. Ethical issue was assured by ethical review board of Jimma University.

Author information




TE and AG designed the study, collected, analyzed, and interpreted the data. TE prepared the manuscript for publication. DD conceived the study. And BG supervised the data collection and reviewed the draft of the manuscript.

Corresponding author

Correspondence to Tesema Etefa Birhanu.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all the participants included in the study.

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Birhanu, T.E., Getachew, B., Gerbi, A. et al. Prevalence of poor sleep quality and its associated factors among hypertensive patients on follow up at Jimma University Medical Center. J Hum Hypertens 35, 94–100 (2021).

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