Cross-sectional associations between actigraphy-measured sleep and 24-h ambulatory blood pressure phenotypes among self-reported short sleepers with elevated blood pressure

Nocturnal blood pressure (BP) phenotypes predict cardiovascular risk, yet most prior work relies on self-reported sleep rather than actigraphy with ambulatory BP monitoring (ABPM). To test whether actigraphy-measured total sleep time (TST) and sleep efficiency (SE) are associated with nocturnal BP phenotypes in adults with elevated BP and habitual short sleep. Baseline data from adults with elevated clinic BP and self-reported sleep < 7 h/night included approximately seven nights of wrist actigraphy and 24-h ABPM. Linear models estimated continuous outcomes, and Poisson regression estimated prevalence ratios (PRs) for systolic/diastolic non-dipping and asleep hypertension across unadjusted, demographic-adjusted, and fully adjusted models. Longer TST was associated with a lower prevalence of diastolic non-dipping in unadjusted (PR per 10 min = 0.989, 95 % CI 0.981–0.997) and demographic-adjusted models (PR = 0.991, 95 % CI 0.984–0.997), with attenuation in fully adjusted models. SE was positively associated with systolic dipping in unadjusted models (β = 0.002, p = 0.036) and was nonsignificant after adjustment. Neither TST nor SE predicted asleep hypertension. Among short-sleeping adults with elevated BP, longer actigraphy-measured TST relates to more favorable nocturnal BP, specifically lower diastolic non-dipping, although effects attenuate with full adjustment. Findings support integrating actigraphy with ABPM to improve characterization of nocturnal BP phenotypes. • Multi-night actigraphy overlapped with 24-h ABPM to assess nocturnal BP phenotypes • Longer total sleep time associated with reduced diastolic non-dipping • Higher sleep efficiency related to greater systolic dipping (unadjusted) • No association observed between sleep measures and asleep hypertension • Objective sleep measures may improve accuracy in identifying asleep BP patterns