The effect of Mid-Day Sleep on blood pressure levels in patients with arterial hypertension


      • Life style changes represent the cornerstone of treatment in patients with arterial hypertension
      • 60 minutes of midday sleep decreased 24h average SBP by 3 mmHg.
      • Reductions as small as 2 mmHg in systolic blood pressure can reduce the risk of hard cardiovascular events by up to 10%


      Study objectives

      Lifestyle changes decrease blood pressure (BP) levels by 3-5 mmHg in hypertensive patients. We assessed the effect of mid-day sleep on BP levels in hypertensive patients.


      We prospectively studied two hundred and twelve hypertensive patients. Mid-day sleep duration, lifestyle habits, anthropometric characteristics, office BP, ambulatory BP monitoring, pulse wave velocity (PWV), augmentation index (AI) were recorded. A standard echocardiographic evaluation was performed.


      53.8% were females, mean age was 62.5±11.0 years and mean body mass index was 28.9±5.4kg/m2. Mean average 24h systolic and diastolic BP (SBP & DBP) was 129.9±13.2/76.7±7.9 mmHg respectively. The majority was non-smokers (70.3%) and did not have diabetes (74.7%). The mean midday sleep duration was 48.7±54.3 min. Average 24h SBP (127.6±12.9 mmHg vs 132.9±13.1 mmHg), average daytime SBP & DBP were lower in patients who sleep at midday, compared to those who do not (128.7±13/76.2±11.5 vs 134.5±13.4/79.5±10.4 mmHg) (p<0.005). The effect was not correlated to the dipping status. Midday sleep duration was negatively correlated with average 24h SBP & daytime SBP. In a linear regression model, for every 60 min of midday sleep, 24h average SBP decreases by 3 mmHg (p<0.001). There were no differences in the number of antihypertensive medications, PWV, AI or echocardiographic indices between study groups.


      Mid-day sleep significantly decreases average 24h and daytime SBP/DBP in hypertensives. Its effect seems to be as potent as other well-established lifestyle changes and is independent of dipping status.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Williams B
        • Mancia G
        • Spiering W
        • et al.
        Authors/Task Force Members: 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension.
        J Hypertens. 2018; 36: 1953-2041
        • Chobanian AV
        • Bakris GL
        • Black HR
        • et al.
        ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee.
        The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21; 289: 2560-2572
        • Naska A
        • Oikonomou E
        • Trichopoulou A
        • Psaltopoulou T
        • Trichopoulos D
        Siesta in healthy adults and coronary mortality in the general population.
        Arch Intern Med. 2007 Feb 12; 167: 296-301
        • Stang A
        • Dragano N
        • Moebus S
        • et al.
        Heinz Nixdorf Recall Investigative Group. Midday naps and the risk of coronary artery disease: results of the Heinz Nixdorf Recall Study.
        Sleep. 2012 Dec 1; 35: 1705-1712
        • Yang L
        • Xu Z
        • He M
        • et al.
        Sleep Duration and Midday Napping with 5-Year Incidence and Reversion of Metabolic Syndrome in Middle-Aged and Older Chinese.
        Sleep. 2016 Nov 1; 39: 1911-1918
        • Cao Z
        • Shen L
        • Wu J
        • et al.
        The effects of midday nap duration on the risk of hypertension in amiddle-aged and older Chinese population: a preliminary evidence from the Tongji-Dongfeng Cohort Study.
        China. J Hypertens. 2014; 32 (discussion 1998): 1993-1998
        • Parati G
        • Stergiou G
        • O'Brien E
        • et al.
        European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.
        J Hypertens. 2014; 32: 1359-1366
        • Godwin M
        • Streight S
        • Dyachuk E
        • et al.
        Testing the Simple Lifestyle Indicator Questionnaire: Initial psychometric study.
        Can Fam Physician. 2008; 54: 76-77
        • Wright JD
        • Hughes JP
        • Ostchega Y
        • Yoon SS
        • Nwankwo T
        Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001-2008.
        Natl Health Stat Report. 2011; 24: 1-22
        • Lewington S
        • Clarke R
        • Qizilbash N
        • Peto R
        • Collins R
        Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
        • Masa JF
        • Rubio M
        • Pérez P
        • Mota M
        • de Cos JS
        • Montserrat JM
        Association between habitual naps and sleep apnea.
        Sleep. 2006; 29: 1463-1468
        • McCarley RW.
        Neurobiology of REM and NREM sleep.
        Sleep Med. 2007; 8: 302-330
        • Irwin M
        • Thompson J
        • Miller C
        • Gillin JC
        • Ziegler M
        Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: clinical implications.
        J Clin Endocrinol Metab. 1999; 84: 1979-1985
        • Lusardi P
        • Zoppi A
        • Preti P
        • Pesce RM
        • Piazza E
        • Fogari R
        Effects of insufficient sleep on blood pressure in hypertensive patients: a 24-h study.
        Am J Hypertens. 1999; 12: 63-68
        • Wingard DL
        • Berkman LF
        Mortality risk associated with sleep patterns among adults.
        Sleep. 1983; 6: 102-107
        • Kripke DF
        • Simon RN
        • Garfinkel L
        • Hammond EC
        Short and long sleep and sleeping pills: is increased mortality associated?.
        Arch Gen Psychiat. 1979; 36: 103-113
        • Bursztyn M
        • Ginsberg G
        • Stessman J
        The siesta and mortality in the elderly: effect of rest without sleep and daytime sleep duration.
        Sleep. 2002; 25: 187-191