The Impact of Nighttime Sleep Quality on the Risk of Hypertension in the Rural Adult Population

Introduction: Sleep is essential for maintaining our physiological circulatory systems. However, with the increasing need for economic activities and productivity, our modern-day population is faced with the rising prevalence of sleep disorders, both in urban and rural communities. This poses a potential risk in cardiovascular disease development, including hypertension.

Objective: To analyze the association between sleep quality and hypertension risk among adults in the rural area of Madiun, Indonesia.

Materials and Methods: This cross-sectional study included 71 participants aged 18 or older from rural communities in Madiun, Indonesia. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using bivariate analysis and multivariate logistic regression.

Results: The prevalence of hypertension and poor sleep quality was 53.5 % and 39.4 %, respectively. Sleep quality was significantly associated with hypertension, with a doubled risk of having hypertension among the youngest adults with poor sleep quality compared to the oldest group in age-adjusted risk (RR for ≤ 40 years old = 3.11 and RR for > 60 years old = 1.27). The associated risk of hypertension posed by sleep quality was independent of sex, BMI, family history, and smoking status.

Conclusion: sleep quality affects hypertension risk despite age, sex, BMI, family history, and smoking status.

1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237. doi: 10.1038/s41581-019-0244-2

2. Kario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47(5):1099-1102. doi: 10.1038/s41440-024-01622-w

3. Kusuma Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of stroke in Indonesia. Int J Stroke. 2009;4(5):379-380. doi: 10.1111/j.1747-4949.2009.00326.x

4. Legramante JM, Galante A. Sleep and hypertension: A challenge for the autonomic regulation of the cardio vascular system. Circulation. 2005;112(6):786-788. doi: 10.1161/CIRCULATIONAHA.105.555714

5. Tang A, Yang E, Ebinger JE. Non-dipping blood pressure or nocturnal hypertension: Does one matter more? Curr Hypertens Rep. 2024;26(1):21-30. doi: 10.1007/S11906-023-01273-1

6. Grassi G, Seravalle G, Quarti-Trevano F, et al. Adrenergic, metabolic, and reflex abnormalities in reverse and extreme dipper hypertensives. Hypertension. 2008;52(5):925-931. doi: 10.1161/HYPERTENSIONAHA.108.116368

7. Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinder liter AL. Nighttime blood pressure dipping: The role of the sympathetic nervous system. Am J Hypertens. 2002;15 (2 Pt 1):111-118. doi: 10.1016/S0895-7061(01)02251-8

8. Kario K, Hoshide S, Mizuno H, et al.; JAMP Study Group. Nighttime blood pressure phenotype and cardiovascular prognosis: Practitioner-based nationwide JAMP study. Circulation. 2020;142(19):1810-1820. doi: 10.1161/CIRCULATIONAHA.120.049730

9. Yuan Y, Heizhati M, Wang L, et al. Poor sleep qua lity is associated with new-onset hypertension in a diverse young and middle-aged population. Sleep Med. 2021;88:189-196. doi: 10.1016/J.SLEEP.2021.10.021

10. Chen S, Song X, Shi H, et al. Association between sleep quality and hypertension in Chinese adults: A cross-sectional analysis in the Tianning Cohort. Nat Sci Sleep. 2022;14:2097-2105. doi: 10.2147/NSS.S388535

11. Akpan EE, Ekrikpo UE, Udo AIA, Bassey BE. Prevalence of hypertension in Akwa Ibom State, South-South Nigeria: Rural versus urban communities study. Int J Hypertens. 2015;2015:975819. doi: 10.1155/2015/975819

12. Samanic CM, Barbour KE, Liu Y, et al. Prevalence of self-reported hypertension and antihypertensive medication use by county and rural-urban classification – United States, 2017. MMWR Morb Mortal Wkly Rep. 2020;69(18):533-539. doi: 10.15585/mmwr.mm6918a1

13. Roshifanni S. Risk of hypertension in people with poor sleep pattern (study in Puskesmas Tanah Kalikedinding Surabaya). Jurnal Berkala Epidemiologi. 2016;4(3):408-419. (In Indonesian.) doi: 10.20473/jbe.v4i3

14. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4

15. Prevalensi, Dampak, serta Upaya Pengendalian Hipertensi dan Diabetes di Indonesia. Badan Kebijakan Pemban gunan Kesehatan, Jakarta, Republik Indonesia; 2024. (In Indonesian.) Accessed January 28, 2026. https://repository.badankebijakan.kemkes.go.id/id/eprint/5536/

16. Camacho PA, Gomez-Arbelaez D, Molina DI, et al. Social disparities explain differences in hypertensi on prevalence, detection and control in Colombia. J Hypertens. 2016;34(12):2344-2352. doi: 10.1097/HJH.0000000000001115

17. Gelassa FR, Birhanu A, Shibiru A, Nagari SL, Jabena DE. Undiagnosed status and associated factors of hypertension among adults living in rural of central, Ethiopia, 2020: Uncovering the hidden magnitude of hypertension. PLoS One. 2022;17(12):e0277709. doi: 10.1371/journal.pone.0277709

18. Chouchou F, Pichot V, Pépin JL, et al.; PROOF Study Group. Sympathetic overactivity due to sleep frag mentation is associated with elevated diurnal systolic blood pressure in healthy elderly subjects: The PROOF- SYNAPSE study. Eur Heart J. 2013;34(28):2122-2131. doi: 10.1093/eurheartj/eht208

19. Fanani MF, Budi Mulia EP, Wardhani FK, et al. Sleep duration was associated with hypertension in adult women: A community-based study on rural population. Anatol J Family Med. 2021;4(3):263-267. doi: 10.5505/anatoljfm.2021.04127

20. Ma GYu, Cai L, Fan LM, et al. Association of socio-economic factors and prevalence of hypertension with sleep disorder among the elderly in rural southwest China. Sleep Med. 2020;71:106-110. doi: 10.1016/j.sleep.2020.03.006

21. Sheehan CM. Rural/nonrural sleep duration patter ns among adults in middle and older adulthood. Sleep Health. 2024;10(2):237-239. doi: 10.1016/J.SLEH.2023.11.007

22. Seravalle G, Mancia G, Grassi G. Sympathetic nervous system, sleep, and hypertension. Curr Hypertens Rep. 2018;20(9):74. doi: 10.1007/s11906-018-0874-y