Among adults with elevated blood pressure, better sleep efficiency, but not longer sleep duration or perceived sleep quality, was linked to lower short-term blood pressure variability.
Key Findings
Results
Higher actigraphy-derived sleep efficiency was significantly associated with lower systolic and diastolic blood pressure variability.
Association was statistically significant for both systolic and diastolic BPV (P < 0.05)
After additional adjustment for BMI, the diastolic association remained significant (P = 0.003) and the systolic association became marginal (P = 0.056)
Linear regression models were adjusted for age, sex, and race as covariates
BPV was quantified as the average real variability of systolic and diastolic pressures derived from 24-h ambulatory blood pressure monitoring
Results
Total sleep time was not independently associated with blood pressure variability.
TST was measured objectively via wrist actigraphy over seven days
No statistically significant relationship was found between TST and either systolic or diastolic BPV
Participants were recruited based on self-reported short sleep of less than 7 hours per night
Results
Subjective sleep measures were not independently related to blood pressure variability.
Three subjective measures were assessed: the Insomnia Severity Index, PROMIS Sleep Disturbance scale, and PROMIS Sleep-Related Impairment scale
None of the subjective sleep measures showed a statistically significant independent relationship with BPV
This contrasted with the objective measure of sleep efficiency, which was significantly associated with BPV
Results
Hourly BPV profiles showed peak blood pressure variability during early morning and late afternoon periods.
24-h ambulatory blood pressure monitoring was used to characterize hourly BPV profiles
Two distinct peak periods were identified: early morning and late afternoon
This diurnal pattern was observed across the study sample
Methods
The study enrolled 200 adults with elevated clinic blood pressure and self-reported short sleep in a cross-sectional baseline analysis.
Mean participant age was 42 ± 11 years
Inclusion criteria required clinic blood pressure of 120–150/80–90 mmHg and self-reported sleep duration less than 7 hours per night
Age range was 18–65 years
Data were collected as baseline measurements from a behavioral sleep-extension trial
Seven days of wrist actigraphy and one 24-h ambulatory blood pressure monitoring session were completed by each participant
What This Means
This research suggests that the quality of sleep — specifically how efficiently a person sleeps — may be more important than how long they sleep when it comes to blood pressure stability throughout the day. The study followed 200 adults who had mildly elevated blood pressure and reported sleeping less than 7 hours per night. Participants wore wrist devices to track sleep objectively for a week and also wore blood pressure monitors for 24 hours. The researchers found that people who slept more efficiently (spending a higher proportion of time in bed actually asleep) had less fluctuation in their blood pressure over the course of the day. Interestingly, total sleep time and how people subjectively felt about their sleep quality did not show the same relationship.
Blood pressure variability — how much blood pressure rises and falls throughout the day — is known to be an independent risk factor for heart attacks and strokes, separate from average blood pressure levels. This study found that the peaks in blood pressure variability tended to occur in the early morning and late afternoon. The finding that sleep efficiency, rather than sleep duration or perceived sleep quality, was the key factor associated with lower variability suggests that the two concepts measure something meaningfully different.
This research suggests that interventions designed to improve sleep efficiency, such as behavioral therapies that reduce time spent awake in bed, could potentially offer cardiovascular benefits beyond simply encouraging people to sleep longer. It also highlights that how well someone sleeps, as objectively measured, may not match how they perceive their own sleep quality, and that both dimensions may matter differently for health outcomes.
Landvatter J, Bress A, Duffecy J, Conroy M, Simonsen S, Baron K. (2026). The role of sleep efficiency in 24-h blood pressure variability.. Journal of hypertension. https://doi.org/10.1097/HJH.0000000000004222