Skip to content
2000
image of A Mixed-Methods Investigation of Sleep Quality and Hypertension Among Adults Attending an Outpatient Department in Thailand

Abstract

Introduction

Sleep problems are increasingly recognized as a factor that may contribute to high blood pressure. Evidence in Asian populations, however, remains limited. This study explored the link between sleep quality and hypertension in middle-aged adults through a mixed-methods design.

Methods

A sequential approach was used, beginning with a cross-sectional survey of 492 adults aged 35–60 years who attended the outpatient clinic at Phramongkutklao Hospital. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while blood pressure was measured by standard procedures. Logistic regression identified predictors of hypertension. In the second phase, 15 participants with poor sleep and/or hypertension were interviewed, and transcripts were analyzed thematically.

Results

Poor sleep quality (PSQI >5) was strongly associated with hypertension (adjusted OR 7.54; 95% CI: 3.33–17.06; < 0.001). Older age, alcohol use, and a family history of hypertension also emerged as independent risk factors. The qualitative findings highlighted three recurring issues: lifestyle and psychological obstacles to adequate sleep, low awareness of the connection between sleep and blood pressure, and limited counseling on sleep health in routine care.

Discussion

These results emphasize the importance of sleep as a modifiable risk factor for hypertension. The lack of awareness among patients and insufficient advice from healthcare providers point to gaps in current practice.

Conclusion

Poor sleep quality is a strong predictor of hypertension among middle-aged adults. Incorporating sleep assessment and education into outpatient services may help improve the prevention and management of hypertension.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/chyr/10.2174/0115734021409893250924122230
2025-10-02
2025-11-16

  • From This Site

    /content/journals/chyr/10.2174/0115734021409893250924122230
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Hypertension. 2025 World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
  2. Ji-Guang W. Chinese guidelines for the prevention and treatment of hypertension. 2025 Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11937835/
  3. Yuan Y. Heizhati M. Wang L. Li M. Lin M. Gan L. Cai X. Yang W. Yao L. Wang Z. Abudereyimu R. Li N. Poor sleep quality is associated with new-onset hypertension in a diverse young and middle-aged population. Sleep Med. 2021 88 Oct 189 196 10.1016/j.sleep.2021.10.021 34781033
    [Google Scholar]
  4. Cao Z. Zhuo F. Yan F. Hu X. Xia G. Huang C. Lu T. Pu Z. Huang R. Chen Z. Sleep disturbance and hypertension mediated by systemic inflammatory response index in NHANES. Sci. Rep. 2025 15 1 24255 10.1038/s41598‑025‑09529‑3 40624232
    [Google Scholar]
  5. Tai B.W.S. Dawood T. Macefield V.G. Yiallourou S.R. The association between sleep duration and muscle sympathetic nerve activity. Clin. Auton. Res. 2023 33 6 647 657 10.1007/s10286‑023‑00965‑7 37543558
    [Google Scholar]
  6. Shiina K. Obstructive sleep apnea -related hypertension: A review of the literature and clinical management strategy. Hypertens. Res. 2024 47 11 3085 3098 10.1038/s41440‑024‑01852‑y 39210083
    [Google Scholar]
  7. Maniaci A. Lavalle S. Parisi F.M. Barbanti M. Cocuzza S. Iannella G. Magliulo G. Pace A. Lentini M. Masiello E. La Via L. Impact of obstructive sleep apnea and sympathetic nervous system on cardiac health: A comprehensive review. J. Cardiovasc. Dev. Dis. 2024 11 7 204 10.3390/jcdd11070204 39057624
    [Google Scholar]
  8. Lo K. Woo B. Wong M. Tam W. Subjective sleep quality, blood pressure, and hypertension: A meta‐analysis. J. Clin. Hypertens. 2018 20 3 592 605 10.1111/jch.13220 29457339
    [Google Scholar]
  9. Pilz N. Narkiewicz K. Wolf J. Kario K. Visser T. Opatz O.S. Reuter A. Dippel L.J. Fesseler L. Heinz V. Patzak A. Bothe T.L. Blood pressure measurement and nocturnal dipping patterns are heavily affected by body posture through changes in hydrostatic pressure between the arm and the heart. Hypertens Res 2025 48 3 1144 1154 10.1038/s41440‑024‑02056‑0 39639129
    [Google Scholar]
  10. Leiva Sisnieguez C.E. Olano R.D. Stavile R.N. Minetto J. Cerri G. Espeche W.G. Carbajal H.A. Salazar M.R. Is the heart rate dipping pattern associated with sleep quality during an ambulatory blood pressure monitoring? A cross-sectional study. J. Hypertens. 2025 43 5 790 796 10.1097/HJH.0000000000003971 39937094
    [Google Scholar]
  11. Exarchakis A. Bayo S. Fink A.M. Martinez D. Inadequate sleep is a risk factor for pediatric hypertension: The pathophysiologic and socioeconomic correlates. Pediatr. Res. 2025 10.1038/s41390‑025‑04199‑3 40562798
    [Google Scholar]
  12. Parati G Pengo MF Avolio A Azizi M Bothe TL Burnier M Cappuccio FP Sierra A Fava C Gironacci MM Hoshide S Kario K Kollias A Lombardi C Maiolino G Maule S Narkiewicz K Ohkubo T Palatini P Pepin JL Sarafidis P Schutte AE Silvani A Stergiou G Verdecchia P Mancia G Bilo G Nocturnal blood pressure: Pathophysiology, measurement and clinical implications. Position paper of the European Society of Hypertension. J Hypertens 2025 43 8 1296 1318 ESH Working Group on Blood Pressure Monitoring and Cardiovascular Variability 10.1097/HJH.0000000000004053 40509714
    [Google Scholar]
  13. Lempiäinen P.A. Ylitalo A. Huikuri H. Kesäniemi Y.A. Ukkola O.H. Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study. J. Hum. Hypertens. 2024 38 5 444 451 10.1038/s41371‑024‑00909‑2 38570625
    [Google Scholar]
  14. Du Y. Zhu B. Liu Y. Zhou W. Du Z. Yang W. Gao C. Association between nocturnal blood pressure phenotype and adverse cardiovascular prognosis in patients with coronary heart disease and hypertension. J. Clin. Hypertens. 2024 26 4 405 415 10.1111/jch.14790 38450952
    [Google Scholar]
  15. Hilmisson H. Thomas R.J. Magnusdottir S. Cardiopulmonary coupling-calculated sleep stability and nocturnal heart rate kinetics as a potential indicator for cardiovascular health: A relationship with blood pressure dipping. Front. Sleep 2024 3 1230958 10.3389/frsle.2024.1230958
    [Google Scholar]
  16. Valencia-Flores M Santiago-Ayala V López Fernández M Moguel Oseguera J Ramirez Payró G Reséndiz-Garcia M Memetla-Argumedo M Gaytán-Cervantes G Morales-Navarro R Aguilar-Salinas CA Bliwise DL Differentiation of the non-dipping blood pressure phenotype in obstructive sleep apnea: An observational study. Ann. Clin. Hypertens. 2025 9 1 001 008 10.29328/journal.ach.1001037
    [Google Scholar]
  17. Patterson P.D. Hostler D. Muldoon M.F. Buysse D.J. Reis S.E. Blunted blood pressure dipping during night shift work: Does it matter? Can we intervene? Am. J. Ind. Med. 2025 68 4 313 320 10.1002/ajim.23711 39953922
    [Google Scholar]
  18. Li X. Heizhati M. Li M. Yao L. Wu T. Yang W. Gan L. Wang H. Liu M. Maitituersun A. Lin M. Hong J. Li N. Poor sleep quality was associated with increased plasma aldosterone concentration in community dwellers, a cross-sectional study. Sci. Rep. 2025 15 1 10817 10.1038/s41598‑025‑91538‑3 40155448
    [Google Scholar]
  19. Liu R.Q. Qian Z. Trevathan E. Chang J.J. Zelicoff A. Hao Y.T. Lin S. Dong G.H. Poor sleep quality associated with high risk of hypertension and elevated blood pressure in China: Results from a large population-based study. Hypertens. Res. 2016 39 1 54 59 10.1038/hr.2015.98 26333359
    [Google Scholar]
  20. Zailinawati A.H. Mazza D. Teng C.L. Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients. Asia Pac. Fam. Med. 2012 11 1 9 10.1186/1447‑056X‑11‑9 23186221
    [Google Scholar]
  21. Zhan Y. Zhang F. Lu L. Wang J. Sun Y. Ding R. Hu D. Yu J. Prevalence of dyslipidemia and its association with insomnia in a community based population in China. BMC Public Health 2014 14 1 1050 10.1186/1471‑2458‑14‑1050 25297696
    [Google Scholar]
  22. Shan Z. Ma H. Xie M. Yan P. Guo Y. Bao W. Rong Y. Jackson C.L. Hu F.B. Liu L. Sleep duration and risk of type 2 diabetes: A meta-analysis of prospective studies. Diabetes Care 2015 38 3 529 537 10.2337/dc14‑2073 25715415
    [Google Scholar]
  23. Wu H. Lv Q. Zhang H. Qin Y. Fang F. Sun H. Wei Y. The reduction of apnea–hypopnea duration ameliorates endothelial dysfunction, vascular inflammation, and systemic hypertension in a rat model of obstructive sleep apnea. Sleep Breath. 2019 23 4 1187 1196 10.1007/s11325‑019‑01798‑3 30762174
    [Google Scholar]
  24. Bjorøy I. Jørgensen V.A. Pallesen S. Bjorvatn B. The prevalence of insomnia subtypes in relation to demographic characteristics, anxiety, depression, alcohol consumption and use of hypnotics. Front. Psychol. 2020 11 527 10.3389/fpsyg.2020.00527 32265811
    [Google Scholar]
  25. Sitasuwan T. Bussaratid S. Ruttanaumpawan P. Chotinaiwattarakul W. Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index. J Med Assoc Thai 2014 97 Suppl 3 S57 S67 24772581
    [Google Scholar]
  26. Chowdhury A.I. Ghosh S. Hasan M.F. Khandakar K.A.S. Azad F. Prevalence of insomnia among university students in South Asian Region: A systematic review of studies. J. Prev. Med. Hyg. 2021 61 4 E525 E529 33628956
    [Google Scholar]
  27. Musa N.A. Moy F.M. Wong L.P. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country. Ind. Health 2018 56 5 407 418 10.2486/indhealth.2018‑0052 29848899
    [Google Scholar]
  28. Mancia G. Grassi G. Mechanisms and clinical implications of blood pressure variability. J. Cardiovasc. Pharmacol. 2000 35 7 S15 S19 10.1097/00005344‑200000004‑00003 11346215
    [Google Scholar]
  29. American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council Sleep duration and quality: Impact on lifestyle behaviors and cardiometabolic health: A scientific statement. St-Onge MP. Grandner MA. Brown D. Circulation 2016 134 18 e367 e386 10.1161/CIR.0000000000000444 27647451
    [Google Scholar]
  30. Chaput J.P. Dutil C. Sampasa-Kanyinga H. Sleeping hours: What is the ideal number and how does age impact this? Nat. Sci. Sleep 2018 10 10 421 430 10.2147/NSS.S163071 30568521
    [Google Scholar]
  31. Lee E.J. Kim S.J. Association of obstructive sleep apnea and uncontrolled hypertension in the middle aged 40–59 in Korean population. J. Korean Med. Sci. 2025 40 24 e129 10.3346/jkms.2025.40.e129 40551608
    [Google Scholar]
  32. WHO South-East Asia Regional Expert Group on Non-Communicable Diseases (REG NCD). 2023 Available from: https://iris.who.int/bitstream/handle/10665/373381/SEA-NCD-105-eng.pdf?sequence=1
  33. Charchar F.J. Prestes P.R. Mills C. Ching S.M. Neupane D. Marques F.Z. Sharman J.E. Vogt L. Burrell L.M. Korostovtseva L. Zec M. Patil M. Schultz M.G. Wallen M.P. Renna N.F. Islam S.M.S. Hiremath S. Gyeltshen T. Chia Y.C. Gupta A. Schutte A.E. Klein B. Borghi C. Browning C.J. Czesnikiewicz-Guzik M. Lee H.Y. Itoh H. Miura K. Brunström M. Campbell N.R.C. Akinnibossun O.A. Veerabhadrappa P. Wainford R.D. Kruger R. Thomas S.A. Komori T. Ralapanawa U. Cornelissen V.A. Kapil V. Li Y. Zhang Y. Jafar T.H. Khan N. Williams B. Stergiou G. Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J. Hypertens. 2024 42 1 23 49 10.1097/HJH.0000000000003563 37712135
    [Google Scholar]
/content/journals/chyr/10.2174/0115734021409893250924122230
Loading
A Mixed-Methods Investigation of Sleep Quality and Hypertension Among Adults Attending an Outpatient Department in Thailand
Bentham Science Publishers ; https://doi.org/10.2174/0115734021409893250924122230
/content/journals/chyr/10.2174/0115734021409893250924122230
/content/journals/chyr/10.2174/0115734021409893250924122230
Loading

Data & Media loading...


  • Article Type:     Research Article
Keywords: Blood pressure ; pittsburgh sleep quality index ; risk factors ; qualitative research ; hypertension ; sleep wake disorders

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test