Hypertension is the major risk factor for cardiovascular and cerebrovascular diseases worldwide. The escalating prevalence of inadequate sleep now parallels that of hypertension. Observational and experimental evidence favoring a causal relation between insufficient sleep and hypertension are particularly compelling - sleeping 6 hours or less per night is associated with a 20-32% higher probability of incident hypertension. Since sleep curtailment is largely voluntary, sleep deficiency may be corrected and the detrimental health consequences potentially reversed. Nevertheless, systematic studies and robust evidence of health-promoting effects of sleep enhancement are lacking, and there are no data regarding the underlying mechanisms that may be involved, especially with regard to blood pressure (BP) control. We seek to overcome these limitations by conducting a randomized controlled study to investigate the effects of 8 weeks of sleep enhancement/extension in prehypertensive and stage 1 hypertensive subjects who report habitual short sleep (<6.5 hours/night). Antihypertensive effects of sleep enhancement achieved through education and behavioral intervention will be compared to a placebo/attention control condition receiving health education. Comprehensive measures, including cardiovascular, metabolic and neuroendocrine markers, complemented by molecular phenotyping and psychological characterization, will generate insights into the mechanisms and mediators linking enhanced sleep to any BP reduction, and to any overall improved cardiovascular risk profile. We propose the following Specific Aims comparing sleep enhancement/extension to placebo/attention control:
Aim 1. To determine the impact of sleep enhancement on 24-hour BP.
Aim 2. To evaluate effects of sleep enhancement on neural circulatory control and vascular function.
Aim 3. To assess changes in systemic and local renin-angiotensin-aldosterone system (RAAS) regulation in response to sleep enhancement.
Aim 4. To identify metabolic and neuroendocrine mediators of the effects of sleep enhancement on BP. This proposal builds upon important strengths, including an interdisciplinary team of investigators with unique experience and expertise in each of the domains investigated, exciting preliminary data, and the minimization of potential confounders. The integration of physiological and molecular variables in a translational framework, complemented by psychological and behavioral characterization, will further bolster the proposed study. Data from these studies will be pivotal in the development and implementation of effective, low cost, health promoting sleep extension strategies applicable both on a targeted and a population-wide basis.
There is considerable evidence that inadequate sleep results in higher blood pressure, and can affect metabolism and hormonal regulation, thus predisposing to risk of diabetes and cardiovascular diseases. We will test the hypothesis that in people who have high blood pressure and are chronically sleep deprived, sleep extension will lower blood pressure and improve metabolic and hormonal function. If our hypothesis is correct, and extending sleep in short sleepers decreases blood pressure significantly, this will be an important way to control blood pressure and improve health status in large numbers of people, lowering the overall health care burden.
| Covassin, Naima; Sert-Kuniyoshi, Fatima H; Singh, Prachi et al. (2018) Experimental Weight Gain Increases Ambulatory Blood Pressure in Healthy Subjects: Implications of Visceral Fat Accumulation. Mayo Clin Proc 93:618-626 |
