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Sleep Efficiency is Inversely Associated with Brachial Artery Diameter and Morning Blood Pressure in Midlife Adults, with a Potential Sex-Effect

  • Thosar, Saurabh S1, 2, 3, 4
  • Chess, Daniel1
  • Bowles, Nicole P1
  • McHill, Andrew W1, 2
  • Butler, Matthew P1, 5
  • Emens, Jonathan S1, 6
  • Shea, Steven A1, 4
  • 1 Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
  • 2 School of Nursing, Oregon Health & Science University, Portland, OR
  • 3 Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
  • 4 OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
  • 5 Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
  • 6 Portland VA Medical Center, Portland, OR, 97239
Published Article
Nature and Science of Sleep
Publication Date
Sep 22, 2021
DOI: 10.2147/NSS.S329359
PMID: 34588831
PMCID: PMC8473571
PubMed Central
  • Original Research


Purpose Sleep efficiency is inversely associated with cardiovascular risk. Brachial artery diameter and flow-mediated dilation (FMD) are noninvasive cardiovascular disease markers. We assessed the associations between sleep efficiency and these vascular markers in midlife adults, including people with sleep apnea. Patients and Methods Thirty (18 males) participants completed an in-laboratory 8-hour sleep opportunity beginning at their habitual bedtimes. Polysomnography was used to assess sleep patterns and sleep efficiency (time asleep/time in bed). We measured systolic and diastolic blood pressure, heart rate, and baseline diameter, and FMD immediately upon awakening in the morning. Mixed model analyses, adjusting for apnea-hypopnea and body mass indices, were used to assess the relationship between overnight sleep efficiency and cardiovascular markers. We also explored sex differences. Results Sleep efficiency was negatively associated with baseline brachial artery diameter (p = 0.005), systolic BP (p = 0.01), and diastolic BP (p = 0.02), but not flow-mediated dilation or heart rate (p > 0.05). These relationships were confirmed with correlations between sleep efficiency and baseline diameter (r = −0.52, p = 0.004), systolic BP (r = −0.43, p = 0.017), and diastolic BP (r = −0.43, p = 0.019). There was a sex-specific interaction trend for sleep efficiency and arterial diameter (p = 0.07) and a significant sex-specific interaction (p < 0.05) for BP, such that the relationships between sleep efficiency and cardiovascular markers were significant in women but not in men. Conclusion In midlife adults, poor sleep efficiency is associated with increased brachial artery diameter and blood pressure, effects that were primarily driven by significant associations in women. These associations could underlie the observed increase in cardiovascular risk in adults with poor sleep and cardiovascular disease.

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