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. 2026 Mar 1;44(3):446-453.
doi: 10.1097/HJH.0000000000004222. Epub 2025 Dec 23.

The role of sleep efficiency in 24-h blood pressure variability

Joshua D Landvatter  1 , Adam Bress  2 , Jenniffer Duffecy  3 , Molly B Conroy  4 , Sara E Simonsen  1 , Kelly Baron  1
Affiliations

The role of sleep efficiency in 24-h blood pressure variability

Joshua D Landvatter et al. J Hypertens. .

Abstract

Background: Blood pressure variability (BPV) is an independent predictor of cardiovascular events, yet its relationship with daily sleep remains unclear. This study examined whether objective and subjective sleep measures are associated with short-term BPV among adults with elevated clinic blood pressure.

Methods: In a cross-sectional baseline analysis from a behavioral sleep-extension trial, adults aged 18-65 years with self-reported short sleep (<7 h/night) and clinic blood pressure 120-150/80-90 mmHg completed seven days of wrist actigraphy and 24-h ambulatory blood pressure monitoring. Objective sleep measures were actigraphy-derived sleep efficiency and total sleep time (TST). Subjective measures included the Insomnia Severity Index and PROMIS Sleep Disturbance and Sleep-Related Impairment scales. BPV was quantified as the average real variability of systolic and diastolic pressures. Linear regression models adjusted for age, sex, and race; additional adjustment for BMI left the diastolic association significant ( P = 0.003) and the systolic association marginal ( P = 0.056).

Results: Among 200 participants (mean age 42 ± 11 years), higher sleep efficiency was associated with lower systolic and diastolic BPV ( P < 0.05). TST and subjective sleep measures were not independently related to BPV. Hourly BPV profiles showed peak variability in early morning and late afternoon periods.

Conclusions: Among adults with elevated blood pressure, better sleep efficiency, but no longer sleep duration or perceived sleep quality, was linked to lower short-term BPV. Interventions improving sleep efficiency may offer cardiovascular benefits beyond extending sleep duration.

Keywords: ambulatory blood pressure; blood pressure variability; cardiovascular risk; sleep efficiency.

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