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• W2034639916 abstract "To the Editor: I thank Dr Kawada for raising interesting points related to our study on sleep duration and risk for hypertension in women, “Sleep Duration and Hypertension With Special Emphasis on Gender and Obesity.” In analyses stratified by age, we found sleep durations of ≤5 hours to be associated with a higher prevalence of hypertension in all age groups and with higher incidence of hypertension only in the younger age group (aged 50 years. The inclusion of older adults in their analyses could have lowered the odds ratio. The sample size in the Whitehall II analysis was also much smaller than that of the Nurses’ Health Study,2 resulting in less statistical power.We explored whether obesity, diabetes, and hypercholesterolemia could have acted as partial mediators in the relationship between sleep duration and hypertension by seeing whether the inclusion of these variables in the multivariate models sufficiently attenuated the associations. Statistical analyses alone cannot distinguish between a confounding variable and a mediating variable. However, results from experimental studies showing that insufficient sleep compromises insulin sensitivity and increases hunger provide plausible mechanisms for the potential for mediation. Although sleep duration has been shown to be associated with diabetes incidence in previous analyses from the Nurses’ Health Study and diabetes was associated with increased risk for hypertension prevalence and incidence (Table 1) in the present study, our results were not consistent with diabetes acting as a partial mediator of the relationships between sleep duration and hypertension. Our results were consistent with obesity acting as a partial mediator. Sleep duration has been shown to be associated with weight gain in data from the Nurses’ Health Study;3 in our analysis, body mass index was associated with hypertension prevalence and incidence (Table 1). As Dr Kawada points out, we were not able to control for the presence of sleep apnea in our analyses; however, we were able to control for snoring and body weight, which are closely related to sleep disordered breathing. Our results lend support to the hypothesis that inadequate sleep plays a role in the etiology of hypertension in some young women and that obesity acts as a partial mediator of this relationship.Table 1.Multivariate analyses using logistic and Cox proportional hazards models to explore the relationship between diabetes and BMI and hypertension." @default.
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• W2034639916 date "2013-10-04" @default.
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• W2034639916 title "Response to Sleep Duration and Hypertension With Special Emphasis on Gender and Obesity" @default.
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• W2034639916 doi "https://doi.org/10.1093/ajh/hpt157" @default.
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