Age and sex differences in sleep disorders as risk factors and markers of hypertension in young people with normal body weight

Objective. To assess age and sex differences in sleep disorders as risk factors and markers of hypertension (HTN) in 18–39-year old people with normal body weight. 
Design and methods. We performed a cross-sectional study based on the internet survey of 18–39-year-old people with body mass index of 18–25 kg/m2  (n = 2094). The unvalidated questionnaire included 42 questions about various types of sleep disorders and sleep-associated symptoms (0 — never, 1 — rarely, 2 — from time to time, 3 — quite often, 4 — almost all the time). 
Results. The probability of detecting HTN in young men with normal body weight is higher than in women with similar characteristics (p < 0,001). In women, the probability of detecting HTN decreases, starting with the youngest category (18–24 years old), reaching a minimum in the age group 30–34 years old and then starts to increase. By the age of 40, the indicators for men and women become similar. Based on a multivariate analysis, the risk of HTN in young people with normal body weight is associated with both gender and age (p = 0,022). The contribution of gender to age-related changes in sleep complaints was found for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p = 0,002). The contribution of gender was also noted for various symptoms — daytime sleepiness, some symptoms of restless legs syndrome (RLS), anxiety, depression, leg cramps (p < 0,001) and nocturnal heartburn (p < 0,001). The contribution of age was noted for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p < 0,001) and for a variety of symptoms — daytime sleepiness, some symptoms of RLS, anxiety, nocturnal cough, and nocturnal choking. 
Conclusions. Our data can be considered when developing measures for HTN prevention, can be recommended for clinical use, as well as in subsequent clinical studies using validated questionnaires.

1.

2. Orlov SN. The membrane theory of the pathogenesis of arterial hypertension: what do we know about this half a century later? Bulletin Sibirskoy Meditsiny = Bulletin of Siberian Medicine. 2019;18(2):234–247. doi:10.20538/1682-0363-2019-2-234-247. In Russian.

3. Kalinkin AL, Sorokin AS. Sleep disorders — risk factors and markers of arterial hypertension in young people with normal body weight. Rossiysky Kardiologichesky Journal = Russian Journal of Cardiology. 2021;26(4):4290. doi:10.15829/1560-4071-2021-4290. In Russian.

4. Niu Y, Sui X, He Y, Xi H, Zhu R, Xu H et al. Association between self-reported snoring and hypertension: a systematic review and meta-analysis. Sleep Med. 2021;88:140–148. doi:10.1016/j.sleep.2021.10.016

5. Han B, Chen WZ, Li YC, Chen J, Zeng ZQ. Sleep and hypertension. Sleep Breath. 2020;24(1):351–356. doi:10.1007/s11325-019-01907-2

6. Seravalle G, Grassi G. Sleep apnea and hypertension. High Blood Press Cardiovasc Prev. 2021. doi:10.1007/s40292-021-00484-4

7. Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841–858. doi:10.1016/j.jacc.2016.11.069

8. Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: a systematic review. Sleep Med Rev. 2018;41:3–38. doi:10.1016/j.smrv.2018.02.003

9. Thomas SJ, Calhoun D. Sleep, insomnia, and hypertension: current findings and future directions. J Am Soc Hypertens. 2017;11(2):122–129. doi:10.1016/j.jash.2016.11.008

10. Shen Y, Liu H, Dai T, Guan Y, Tu J, Nie H. Association between restless legs syndrome and hypertension: a meta-analysis of nine population-based studies. Association between restless legs syndrome and hypertension: a meta-analysis of nine populationbased studies. Neurol Sci. 2018;39(2):235–242. doi:10.1007/s10072-017-3182-4

11. Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: a systematic review and new concept. J Neurology. 2016;86(14):1336–1343. doi:10.1212/WNL.0000000000002542

12. Schwartz SH, Bilsky, W. Toward a theory of the universal content and structure of values: extensions and cross-cultural replications. J Personality Social Psychol. 1990;58:878–891. doi:10.1037/0022-3514.58.5.878

13. Schwartz SH. Universals in content and structure of values: theoretical advances and empirical tests in 20 countries. Adv Exper Soc Psychol. 1992;25:1–65. doi:10.1016/S0065-2601(08)60281-6

14. Lim LF, Solmi M, Cortese S. Association between anxiety and hypertension in adults: a systematic review and metaanalysis. Neurosci Biobehav Rev. 2021;131:96–119. doi:10.1016/j.neubiorev.2021.08.031