Cross-sectional associations between actigraphy-measured sleep and 24-h ambulatory blood pressure phenotypes among self-reported short sleepers with elevated blood pressure.
Landvatter J, Bress A, et al. • Sleep medicine • 2026
Among short-sleeping adults with elevated blood pressure, longer actigraphy-measured total sleep time relates to more favorable nocturnal BP, specifically lower diastolic non-dipping, although effects attenuate with full adjustment.
Key Findings
Results
Longer actigraphy-measured total sleep time (TST) was associated with a lower prevalence of diastolic non-dipping in unadjusted and demographic-adjusted models.
In unadjusted models, PR per 10 minutes of TST = 0.989 (95% CI 0.981–0.997)
In demographic-adjusted models, PR = 0.991 (95% CI 0.984–0.997)
The association attenuated and was no longer significant in fully adjusted models
Participants were adults with elevated clinic BP and self-reported sleep <7 h/night
Sleep was measured using approximately seven nights of wrist actigraphy
Results
Sleep efficiency (SE) was positively associated with systolic dipping in unadjusted models but became nonsignificant after adjustment.
Unadjusted association: β = 0.002, p = 0.036
The association was nonsignificant after demographic and full adjustment
SE was measured via wrist actigraphy over approximately seven nights
Systolic dipping was estimated as a continuous outcome using linear models
Results
Neither TST nor SE predicted asleep hypertension.
Asleep hypertension was assessed as a binary outcome using Poisson regression to estimate prevalence ratios
This null finding held across unadjusted, demographic-adjusted, and fully adjusted models
24-hour ambulatory blood pressure monitoring (ABPM) was used to characterize nocturnal BP phenotypes
Methods
The study used Poisson regression to estimate prevalence ratios for systolic and diastolic non-dipping and asleep hypertension across multiple model adjustment levels.
Three model levels were applied: unadjusted, demographic-adjusted, and fully adjusted
Linear models were used for continuous BP outcomes; Poisson regression was used for categorical nocturnal BP phenotypes
Baseline data were drawn from adults with elevated clinic BP and self-reported habitual short sleep (<7 h/night)
Actigraphy data spanned approximately seven nights alongside concurrent 24-h ABPM
Conclusions
The authors conclude that findings support integrating actigraphy with ABPM to improve characterization of nocturnal blood pressure phenotypes.
Prior work in this area has largely relied on self-reported sleep rather than objective actigraphy measures
The study population was specifically adults with both elevated BP and habitual short sleep, a high-cardiovascular-risk group
Nocturnal BP phenotypes, including non-dipping and asleep hypertension, are established predictors of cardiovascular risk
What This Means
This research suggests that among adults who habitually sleep fewer than 7 hours per night and have elevated blood pressure, getting more sleep — as objectively measured by a wrist activity tracker over about a week — is linked to healthier nighttime blood pressure patterns. Specifically, people who slept longer were less likely to show 'diastolic non-dipping,' a pattern where blood pressure fails to drop adequately during sleep, which is considered a cardiovascular risk factor. This association was present in basic and demographic-adjusted analyses, though it weakened when additional health and lifestyle factors were taken into account.
The study also found a weak positive relationship between sleep efficiency (how much of time in bed is actually spent asleep) and the degree to which systolic blood pressure dips at night, but this association disappeared after statistical adjustment. Neither total sleep time nor sleep efficiency predicted whether someone would have outright high blood pressure during sleep (asleep hypertension).
This research matters because it moves beyond self-reported sleep estimates and uses objective wrist actigraphy alongside 24-hour ambulatory blood pressure monitoring — a more rigorous approach for capturing real-world sleep and nighttime blood pressure simultaneously. The findings suggest that objective sleep measurement tools could help better identify people at risk for abnormal nocturnal blood pressure patterns, which are known to predict heart disease and stroke risk. However, the attenuation of effects after full adjustment points to the complexity of the relationship and the need for further research in this area.
Landvatter J, Bress A, Duffecy J, Simonsen S, Allen C, Baron K. (2026). Cross-sectional associations between actigraphy-measured sleep and 24-h ambulatory blood pressure phenotypes among self-reported short sleepers with elevated blood pressure.. Sleep medicine. https://doi.org/10.1016/j.sleep.2026.108780