title: Insomnia with physiological hyperarousal is associated with hypertension.
abstract: Previous studies have suggested that insomnia with objective short sleep duration is associated with a higher risk of hypertension, and it has been speculated that the underlying mechanism is physiological hyperarousal. In this study, we tested whether insomnia with physiological hyperarousal measured by Multiple Sleep Latency Test (MSLT), a standard test of sleepiness/alertness, is associated with increased risk of hypertension. Two hundred nineteen chronic insomniacs and 96 normal sleepers were included in this study. Chronic insomnia was defined based on standard diagnostic criteria with symptoms lasting ≥6 months. All subjects underwent 1 night in laboratory polysomnography followed by a standard MSLT. We used the median mean MSLT value (ie, >14 minutes) and the 75th percentile of mean MSLT value (ie, >17 minutes) to define hyperarousal. Hypertension was defined based either on blood pressure measures or on diagnosis treatment by a physician. After controlling for age, sex, body mass index, apnea-hypopnea index, diabetes mellitus, smoking, alcohol, and caffeine use, insomnia combined with MSLT >14 minutes increased the odds of hypertension by 300% (odds ratio=3.27; 95% confidence interval=1.20-8.96), whereas insomnia combined with MSLT >17 minutes increased even further the odds of hypertension by 400% (odds ratio=4.33; 95% confidence interval=1.48-12.68) compared with normal sleepers with MSLT ≤14 minutes. Insomnia associated with physiological hyperarousal is associated with a significant risk of hypertension. Long MSLT values may be a reliable index of the physiological hyperarousal and biological severity of chronic insomnia.
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.). xiangdong.tang@gmail.com avgontzas@psu.edu.
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Julio
authors.initials: J
authors.lastname: Fernandez-Mendoza
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Edward O
authors.initials: EO
authors.lastname: Bixler
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Yuanfeng
authors.initials: Y
authors.lastname: Sun
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Junying
authors.initials: J
authors.lastname: Zhou
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Rong
authors.initials: R
authors.lastname: Ren
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.).
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: From the Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Y.L., Y.S., J.Z., R.R., T.L., X.T.) and Department of Psychiatry, Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey (Y.L., A.N.V., J.F.-M., E.O.B.). xiangdong.tang@gmail.com avgontzas@psu.edu.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Tang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D012720:Severity of Illness Index; D020921:Sleep Arousal Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
keywords: hypertension; insomnia; multiple sleep latency test; physiological hyperarousal; sleep; sleep initiation and maintenance disorders