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. 2024 Mar 11;47(3):zsae001.
doi: 10.1093/sleep/zsae001.

The interrelationships between sleep regularity, obstructive sleep apnea, and hypertension in a middle-aged community population

Kelly Sansom  1   2   3 , Amy Reynolds  3 , Daniel Windred  4 , Andrew Phillips  4 , Satvinder S Dhaliwal  5   6   7   8 , Jennifer Walsh  1   2   9 , Kathleen Maddison  1   2   9 , Bhajan Singh  1   2   9 , Peter Eastwood  10 , Nigel McArdle  1   2   9
Affiliations

The interrelationships between sleep regularity, obstructive sleep apnea, and hypertension in a middle-aged community population

Kelly Sansom et al. Sleep. .

Abstract

Study objectives: Little is known about the interrelationships between sleep regularity, obstructive sleep apnea (OSA) and important health markers. This study examined whether irregular sleep is associated with OSA and hypertension, and if this modifies the known association between OSA and hypertension.

Methods: Six hundred and two adults (age mean(SD) = 56.96(5.51) years, female = 60%) from the Raine Study who were not evening or night shift workers were assessed for OSA (in-laboratory polysomnography; apnea-hypopnea index ≥ 15 events/hour), hypertension (doctor diagnosed, or systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg) and sleep (wrist actigraphy for ≥5 days). A sleep regularity index (SRI) was determined from actigraphy. Participants were categorized by tertiles as severely irregular, mildly irregular, or regular sleepers. Logistic regression models examined the interrelationships between SRI, OSA and hypertension. Covariates included age, sex, body mass index, actigraphy sleep duration, insomnia, depression, activity, alcohol, smoking, and antihypertensive medication.

Results: Compared to regular sleepers, participants with mildly irregular (OR 1.97, 95% confidence intervals [CI] 1.20 to 3.27) and severely irregular (OR 2.06, 95% CI: 1.25 to 3.42) sleep had greater odds of OSA. Compared to those with no OSA and regular sleep, OSA and severely irregular sleep combined had the highest odds of hypertension (OR 2.34 95% CI: 1.07 to 5.12; p for interaction = 0.02) while those with OSA and regular/mildly irregular sleep were not at increased risk (p for interaction = 0.20).

Conclusions: Sleep irregularity may be an important modifiable target for hypertension among those with OSA.

Keywords: actigraphy; hypertension; obstructive sleep apnea; patterns; sleep regularity.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Raster plot of an irregular and regular sleep pattern. Panel A represents a regular sleeper with an SRI score of 94.8 and panel B represents an individual with a sleep regularity index (SRI) score of 24.5 (irregular). The solid lines represent episodes of sleep.
Figure 2.
Figure 2.
Participant flow diagram.
Figure 3.
Figure 3.
Association between sleep regularity and OSA severity. Odds ratio for obstructive sleep apnea (AHI ≥ 15 events/hour), Time with SpO2 < 90% (T90; ≥median) and Arousal index (arousal ≥ median events/hour) across regular = reference group (n = 200), mildly irregular (n = 201) and severely irregular (n = 201) groups. Error bars reflect 95% confidence interval of odds ratio. Variables assessed as potential covariates for models were age, sex, body mass index, alcohol, smoking, physical activity, actigraphy sleep duration, depressive symptoms, and insomnia symptoms. Covariates were excluded if p-value > 0.05 or multicollinearity existed.
Figure 4.
Figure 4.
Odds ratio of hypertension across sleep regularity and OSA groups combined. Error bars reflect 95% confidence interval of odds ratio and N represents the number of observations per each group. Variables assessed as potential covariates for models were age, sex, body mass index, alcohol, smoking, physical activity, actigraphy sleep duration, depressive symptoms, insomnia symptoms, apnea–hypopnea index, and antihypertensive medication. Covariates were excluded if p-value > 0.05 or multicollinearity existed. N = number of observations.
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