Erratic Sleep Habits Linked to High Blood Pressure in Teens

Irregular sleep schedules contributed to increased blood pressure even when youth had the recommended total hours of rest.

Highlights:

The association between obesity and increased blood pressure in teens was stronger in those who also had irregular sleep patterns
Among youth with higher visceral fat (excess weight in the belly/abdominal area), irregular sleep habits contributed to raised blood pressure
School schedules and extracurricular obligations frequently clash with teens' natural predisposition to go to bed later and sleep later, which may result in inconsistent sleep timing and a cascade of effects for heart health later in life

Staying up later at night and sleeping in on weekends are typical adolescent behaviors; however, erratic sleep patterns may have long-term consequences for heart health by increasing blood pressure in teens with more abdominal fat, according to new research published today in Hypertension, an American Heart Association journal.

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‘Staying awake later at night and sleeping in on weekends are characteristics of adolescent behavior. Yet, irregular sleep patterns may have long-term effects on heart health by raising blood pressure in youth with higher abdominal obesity.’

Check Sleeping Pattern in Teenagers Experiencing Weight Gain

“Pediatricians should pay close attention to youth who are experiencing weight gain or have already become overweight and examine their sleep patterns, since a more regular sleep schedule may help them with weight loss and improve their long-term heart health,” said Julio Fernandez-Mendoza, Ph.D., senior author of the study, an associate professor at the Penn State College of Medicine and sleep psychologist at the Sleep Research & Treatment Center of Penn State College of Medicine in Hershey, Pennsylvania.

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Cardiovascular Health in Teenagers

According to the American Heart Association's Life's Essential 8, which also includes physical activity, not smoking, a healthy weight, and good levels of cholesterol, blood sugar, and blood pressure, enough sleep is an important aspect of overall cardiovascular health. Teens aged 13 to 18 should get 8 to 10 hours of sleep per night, according to the Association's cardiovascular health metrics.

The researchers assessed sleep, visceral fat, and blood pressure in 303 teenagers from central Pennsylvania (average age 16.2 years; 47.5% female; 21.5% Black or Hispanic) who had previously participated in the Penn State Child Cohort study as children. Sleep was assessed in the sleep lab for one night and at home for seven days using a wristwatch-like sleep monitoring device. Researchers used this device to assess sleep length and variability (how much and how little adolescents slept from night to night), as well as sleep midpoint (the period between sleep and wake-up) and its consistency (to capture their sleep patterns over time). During the school week, a sleep midpoint of 2 a.m. or later is deemed delayed, and night-to-night changes of 45 minutes or more in the sleep midpoint are considered very irregular.

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Visceral Fat is Dangerous to Heart Health

At the sleep lab visit, visceral abdominal fat (the deep belly fat that surrounds the stomach, liver, and intestines) was assessed using a dual-energy, X-ray absorptiometry (DEXA) scan. Visceral fat is more hazardous to heart health than subcutaneous fat. During the sleep lab visit, seated blood pressure was checked three times at 5-minute intervals, with the latest two readings averaged.

Among the findings were:

Overall, the participants had typical adolescent sleep habits, such as going to bed later than they did in grade school and sleeping later on weekends and school breaks than on school days.
Each unit increase in visceral abdominal fat was associated with a 7 mm Hg higher systolic (top number) blood pressure and a 3 mm Hg higher diastolic (bottom number) blood pressure among the adolescents studied during the school year and whose sleep varied by 45 minutes or more during the school week.
There was no association between visceral belly fat and increased blood pressure among youths whose sleep changed by less than 45 minutes over the school week.
Each unit increase in visceral abdomen fat was associated with a 5 mm Hg increase in systolic blood pressure and a 2 mm Hg increase in diastolic blood pressure in those who fell asleep later on weekdays (with a sleep midpoint of 2 a.m. or later). There was no link between visceral belly fat and high blood pressure in individuals who went to bed earlier.
Neither a delayed sleep midpoint nor sleep regularity significantly affected the association between visceral belly fat and blood pressure among the youths who took part in the trial during a school break.

Having a Regular Sleep Pattern is Healthy

“These results suggest that keeping a regular sleep pattern may protect adolescents from the cardiovascular consequences of obesity,” said Natasha Morales-Ghinaglia, B.S., first author of the study and an American Heart Association predoctoral fellow at the Penn State College of Medicine Sleep Research & Treatment Center in Hummelstown, Pennsylvania.

Morales-Ghinaglia added, “Teens are not wrong in following their normal inclinations to sleep later than in their childhood years. Rather, it’s a normal developmental pattern that previous studies have shown to be at odds with certain aspects of teen lifestyle - primarily school and extracurricular activity schedules.”

'Evening People' at Risk of Obesity and High Blood Pressure

In youth who defined themselves as "evening people," each unit increase in visceral abdomen fat was connected to around a 3 mm Hg higher diastolic blood pressure, however, among self-described "morning persons," there was no impact of visceral abdominal fat on blood pressure.

Sleep specialists have stated that early middle and high school start times frequently make it difficult for teens to obtain enough sleep daily. Morales-Ghinaglia encourages parents and teenagers to be aware of their bodies demands. “It’s important to educate teens on how important it is to have regular sleep. They don’t need an early bedtime like younger children, but it’s important to get more regular sleep for the benefit of their heart and mental health.”

Changes in middle and high school start times, as well as other potential interventions such as educating administrators, teachers, school clinicians, parents, and youth on sleep and circadian rhythms, may improve school attendance, academic performance, and emotional functioning, according to Fernandez-Mendoza. “It is time to raise awareness that having a misalignment between sleep patterns and school schedules may mean more obesity, more depression, worse performance and more heart disease among adolescents.”

There are various limitations to the study. The results cannot indicate a cause-and-effect relationship between sleep habits and blood pressure because it was not a controlled experiment in which researchers could compare groups based on criteria such as sleep conditions or patterns and because the subjects were assessed at a single time. One night in the sleep lab and seven nights at home were used to evaluate sleep, which may not be as reliable as measures from more than one night in a sleep lab and 14 nights or more of home monitoring to capture more weekend nights. Blood pressure was solely measured in the lab, which may be a less accurate representation of typical blood pressure levels, such as those obtained during 24-hour monitoring with numerous measurements.

Source-Medindia