基于智能穿戴设备探讨睡眠时长与高血压关系的真实世界研究

目的 基于智能穿戴设备测量睡眠时长与家庭血压,明确睡眠时长与高血压的关联性。方法 本研究数据资料来自由中国医疗保健国际交流促进会发起的“血压健康研究”,由中国人民解放军总医院执行。本研究采用在线招募方式,招募来自全国34个省、自治区、直辖市的受试者。根据纳入与排除标准,2021年12月至2023年1月共纳入1706例既往无高血压病史的成年受试者,采用华为智能血压手表测量睡眠数据及家庭血压数据,通过填写电子问卷收集受试者人口学资料和病史等信息。按照基线时血压测量数值将受试者分为高血压组[收缩压(SBP)≥135mmHg(1mmHg=0.133kPa),和(或)舒张压(DBP)≥85mmHg,n=851]和非高血压组(SBP＜135mmHg,且DBP＜85mmHg,n=855)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归分析睡眠时长与高血压之间的横断面关系。结果 1706例受试者中男性1519例(89.04%),女性187例(10.96%)；年龄(44.87±11.52)岁；体质量指数(BMI)为(24.99±3.33)kg/m²；睡眠时长(7.35±1.10)h；收缩压(125.97±11.75)mmHg,舒张压(84.66±8.45)mmHg；心率(77.43±9.63)次/min。在不同睡眠时长(≥9h、7~<9h、5~<7h、<5h)受试者中,高血压患病率比较(45.26%、48.16%、52.63%和67.65%),差异有统计学意义(P=0.046)。随着睡眠时长缩短,高血压患病率有增高趋势。未校正混杂因素的多因素logistic回归分析结果显示,与睡眠时长7~<9h组比较,睡眠时长≥9h组(OR=0.890,95%CI 0.583~1.358；P=0.589)及睡眠时长5~<7h组(OR=1.196,95%CI 0.974~1.469；P=0.088)高血压风险无统计学差异；睡眠时长<5h组(OR=2.250,95%CI 1.086~4.665；P=0.029)的受试者高血压风险增加。校正了所有可获取混杂因素(年龄、性别、BMI、高盐饮食习惯、吸烟/饮酒史、呼吸睡眠暂停综合征史、糖尿病史、慢性肾脏病史等)后,与睡眠时长7~<9h组的受试者比较,睡眠时长≥9h组(OR=0.952,95%CI 0.606~1.495；P=0.831)及睡眠时长5~<7h组(OR=1.056,95%CI 0.848~1.315；P=0.625)高血压风险无统计学差异；睡眠时长<5h组(OR=2.238,95%CI 1.026~4.884；P=0.043)受试者的高血压风险依然增加。结论 睡眠时长过长及睡眠时长轻度不足与高血压风险无显著关联,睡眠时长过短与高血压风险增加显著关联。

A real-world study on relationship between sleep duration and hypertension based on smart wearable devices

Objective To investigate the correlation between sleep duration and hypertension based on the data collected through smart wearable devices. Methods The data in this study were from Blood Pressure Health Study (initiated by China International Exchange and Promotive Association for Medical and Health Care and executed by Chines PLA General Hospital). All participants were recruited online from 34 provinces, autonomous regions, and municipalities. Based on our inclusion/exclusion criteria, a total of 1 706 adult participants with no history of hypertension were recruited to this study from December, 2021 to January, 2024. Huawei smart blood pressure watches were employed to measure and collect sleep and home blood pressure data, and their demographic information and medical history were collected through electronic questionnaires. Based on their baseline blood pressure, they were divided into hypertensive group [SBP ≥135 mmHg (1mmHg=0.133kPa) and/or DBP ≥85 mmHg, n=851] and non-hypertensive group (SBP <135 mmHg and DBP<85 mmHg). SPSS statistics 26.0 was used for data analysis. Data comparison between the two groups was performed using student′s t test or Chi-square test depending on data type. Multivariate logistic regression analysis was used to examine the cross-sectional relationship between sleep duration and hypertension. Results Among the 1 706 participants, there were 1 519 males (89.04%) and 187 females (10.96%), with an average age of (44.87±11.52) years, a body mass index (BMI) of (24.99±3.33) kg/m², a sleep duration of (7.35±1.10) h, SBP of (125.97±11.75) mmHg, DBP of (84.66±8.45) mmHg, and a heart rate of (77.43±9.63) beats/min. In the participants with different sleep durations (≥9,7-<9,5-<7 and <5 h), there was a significant difference in the prevalence of hypertension (45.26% vs 48.16% vs 52.63% vs 67.65%; P=0.046), indicating an increasing trend in hypertension prevalence with shorter sleep duration. Multivariate logistic regression analysis without adjusting for confounding factors showed that compared to the group with a sleep duration of 7-<9 h, the group with a duration of ≥9 h (OR=0.890, 95%CI 0.583-1.358; P=0.589) and the group of 5-<7 h (OR=1.196, 95%CI 0.974-1.469; P=0.088) showed no statistical difference in hypertension risk, and the group with a duration of <5 h (OR=2.250, 95%CI 1.086-4.665; P=0.029) had an increased risk of hypertension. After adjusting for all available confounding factors (age, gender, BMI, high-salt diet habits, smoking/alcohol history, history of sleep apnea syndrome, diabetes history, history of chronic kidney disease, etc.), compared to the participants with a sleep duration of 7-<9 h, the group with a sleep duration of ≥9 h (OR=0.952, 95%CI 0.606-1.495; P=0.831) and the group with a sleep duration of 5-<7 h (OR=1.056, 95%CI 0.848-1.315; P=0.625) showed no statistically significant difference in hypertension risk, whereas those with a sleep duration of <5 h (OR=2.238, 95%CI 1.026-4.884; P=0.043) still had an increased risk of hypertension. Conclusion There is no significant correlation between mild shortfall and excessive sleep duration and hypertension risk, but obvious association is found between excessively short sleep duration and an increased risk of hypertension.