Video Abstract
Sleep promotion is not specifically recommended as a target for hypertension management. We examined associations of sleep duration and timing with blood pressure parameters in patients referred to pediatric nephrology clinic for elevated blood pressure evaluation.
This is a retrospective study of initial ambulatory blood pressure monitoring data and self-report sleep data collected from patients referred to nephrology clinic for the evaluation of elevated blood pressure. Linear and logistic regression modeling determined associations between sleep exposures (duration and timing) and continuous and dichotomous blood pressure outcomes, respectively, adjusted for age, sex, body mass index, and weekday versus weekend status.
The study sample included 539 patients with mean age 14.6 years and 56% meeting hypertension criteria. Sleep duration averaged 9.1 hours per night. Average timing of sleep onset and offset were 11:06 pm and 8:18 am, respectively. Longer sleep duration was associated with better daytime blood pressure parameters (eg, every extra hour of sleep duration was associated with a reduced odds of wake hypertension [odds ratio, 0.88; 95% CI, 0.79–0.99]). Later sleep onset was associated with worse daytime blood pressure parameters (eg, each additional hour of later sleep onset was associated with higher wake systolic blood pressure index [mean wake blood pressure/95th percentile]) (β = 0.07; 95% CI, 0.02–0.13). Associations were consistent across sex, age, body mass index, and weekday status.
Longer sleep duration and earlier sleep onset were associated with lower blood pressure. This suggests that sleep optimization may be an important target for intervention in hypertension management.
Comments
Chronobiological Interventions in Youth to Mitigate Cardiovascular Risk
Sleep extension interventions are effective in increasing short-term sleep duration across various populations.2 These approaches may include sleep hygiene, sleep education, stimulus control, bedtime advancement, and behavioral coaching and training, such as goal setting and self-monitoring. Further, music therapy has emerged as a promising tool to improve sleep health. When carefully selected and integrated into a personalized protocol by trained music therapists, music can provide emotional comfort, promote relaxation, and reduce anxiety, all of which are factors that contribute to enhanced sleep outcomes.3 Music therapy can be particularly impactful when considering the cultural and emotional needs of adolescents, as personalized music interventions can strengthen their connection to the therapeutic process while expanding the range of possible nonpharmacologic strategies.
Specifically, the “Charge Your Brainzz” intervention consists of three 45-minute classroom sessions, interactive assignments, and a supporting website, designed to educate high school students on the importance of sleep health, the biological clock, and improving sleep hygiene.4 The program successfully increased students’ sleep knowledge, positive attitudes toward healthy sleep practices, and perceived behavioral control, which are key predictors of behavior change. However, a program like this hinges on contextualizing the intervention across several determinants of youth daily routines. Adolescents especially face competing demands of academic pressures, extracurricular activities, and social media use, which can undermine the impact of programs unless these factors are directly addressed. A more flexible and integrative strategy, which includes family involvement, school policies, and peer support systems, could increase sustained engagement and adherence, thereby amplifying the benefits for BP regulation.
Yet another complication against sleep health is excessive social media use, particularly at bedtime, which can disrupt sleep by delaying sleep onset, reducing sleep duration, and shifting circadian rhythms, contributing to poor sleep quality and increased risk of mental health issues.5 Interventions that target the reduction of screen time both in general and in the hours before bedtime, coupled with public awareness campaigns, could serve as countermeasures and guide communities on a path towards effectively combating the dual crises of cardiovascular disease and youth mental health.
The convergence of sleep disruption, cardiovascular risk, and mental health challenges in today’s youth requires innovative, multimodal interventions that acknowledge and properly address the sleep-related determinants of biological imperatives, an adolescent developmental period of growing autonomy, and modern sociocultural and academic pressures. Future research may explore the potential of chronotherapy-informed health literacy programs and individualized behavioral interventions to create a more comprehensive, anti-digital, and anti-technology framework for youth’s long-term mental, physical, and overall well-being.
References
1. Kogon AJ, Maqsood AM, LoGuidice J, Amaral S, Meyers K, Mitchell JA. Sleep Duration and Blood Pressure in Youth Referred for Elevated Blood Pressure Evaluation. Pediatrics. 2024;154(1):e2023062940. doi:10.1542/peds.2023-062940
2. Baron KG, Duffecy J, Reutrakul S, et al. Behavioral interventions to extend sleep duration: A systematic review and meta-analysis. Sleep Medicine Reviews. 2021;60:101532. doi:10.1016/j.smrv.2021.101532
3. Loewy J. Music Therapy as a Potential Intervention for Sleep Improvement. Nature and Science of Sleep. 2020;12(12):1-9. doi:10.2147/NSS.S194938
4. Inhulsen MMR, Busch V, Stralen MM. Effect Evaluation of a School‐Based Intervention Promoting Sleep in Adolescents: A Cluster‐Randomized Controlled Trial. Journal of School Health. 2022. doi:10.1111/josh.13175
5. Alonzo R, Hussain J, Stranges S, Anderson KK. Interplay between Social Media Use, Sleep Quality, and Mental Health in Youth: a Systematic Review. Sleep Medicine Reviews. 2021;56:101414. doi:10.1016/j.smrv.2020.101414