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Can Sleep Promotion Help Lower Hypertension in Children?

Researchers at CHOP and Penn are studying how sleep duration and timing may affect hypertension in children.
The findings:
Researchers from Children's Hospital of Philadelphia identified associations between sleep duration, timing, and hypertension – high blood pressure – in children. Longer sleep duration reduced the odds of hypertension when awake and resulted in a lower wake systolic blood pressure index. Additionally, going to sleep earlier was associated with lower wake systolic and diastolic index.
Why it matters:
Children with hypertension are likely to remain hypertensive into adulthood and experience accelerated cardiovascular disease, which is one of the leading causes of morbidity and early mortality in the United States. The current standard of care upon diagnosis of hypertension in children involves lifestyle changes to diet and physical activity, but sleep promotion is not explicitly included. The study results suggest that interventions to optimize sleep duration and sleep onset could serve as another beneficial non-pharmacologic therapy to improve blood pressure and reduce associated complications.
Who conducted the study:
Researchers from the Division of Nephrology at CHOP helped conduct the study, including first author Amy Kogon, MD, MPH, and co-authors Anam M. Maqsood, MD, Kevin Meyers, Jill LoGuidice, and, Sandra Amaral, MD, MHS, from the Division of Nephrology. Jonathan Mitchell, PhD, from the Division of Gastroenterology, Hepatology, and Nutrition was the senior author.
How they did it:
This retrospective study collected data from 539 patients referred to the nephrology clinic at CHOP for the evaluation of high blood pressure. Researchers measured blood pressure outcomes such as wake blood pressure, sleep blood pressure, and nocturnal dipping (nocturnal blood pressure decrease compared to daytime blood pressure) using ambulatory blood pressure monitoring, which gauges blood pressure over a 24-hour period by taking assessments at regular intervals. Patients also self-reported sleep data, including what time they went to sleep, what time they woke up, and how long they slept.
Using linear and logistic regression models, researchers determined the associations between sleep exposures like duration and timing, and continuous and dichotomous blood pressure outcomes that were adjusted for age, sex, body mass index, and weekday versus weekend.
Quick thoughts:
"Hypertension is a common problem in children," Dr. Kogon said. "Our paper showed that children who sleep longer have lower blood pressure. These findings suggest that focusing on improving children's sleep may be a new approach to decreasing blood pressure, in addition to focusing on diet, exercise, and medication. Building on these results, we plan to study whether improving sleep health is an effective first line therapy to treat adolescents with hypertension. We are very excited about the possibilities."
What's next:
Future studies will further explore the role of sleep interventions as an effective treatment for hypertension while considering how sleep disorders like sleep apnea and overall sleep quality may affect treatment.
Where the study was published:
The study appears in Pediatrics. Also, view a corresponding video abstract.