AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Longitudinal Associations of Sleep Quality, Insomnia Symptoms, and Obstructive Sleep Apnea Risk with Blood Pressure and Hypertension in Women: A 10-Year Follow-Up of the AHA Go Red for Women Strategically Focused Research Network
By Dudzik J, Igbinedion E, Eslami S et al.
Introduction: Sleep is a multidimensional health behavior encompassing sleep quality, duration, and sleep disorders. Although poor sleep has been associated with hypertension (HTN) and CVD, few studies have examined whether multiple dimensions of sleep health are associated with BP and HTN risk, measured a decade later, among diverse midlife women. Objective: : To evaluate longitudinal associations of baseline sleep quality, duration, insomnia symptoms, and obstructive sleep apnea (OSA) risk with in-office BP (oBP), ambulatory BP (aBP), and HTN risk ~10 years later in a diverse cohort of women. Methods: Women enrolled in the Columbia University AHA Go Red for Women Strategically Focused Research Network in 2016 were evaluated 9-10 years later (2025-26). Baseline sleep quality and duration were measured using the Pittsburgh Sleep Quality Index (PSQI), insomnia symptoms using the Insomnia Severity Index (ISI), and OSA risk using the Berlin Questionnaire. In-office and 24-hr ambulatory monitoring of systolic (SBP) and diastolic (DBP) BP were measured at follow-up. HTN was defined by elevated BP (≥130/80 mmHg), self-reported antihypertensive medication use, or physician diagnosis. Multivariable linear and logistic regression models examined associations of baseline sleep characteristics with 10-year BP and HTN risk, adjusting for age, race/ethnicity, insurance, menopausal status, BMI, and physical activity (PA). Results: Follow-up data were available for 90 women, 18% of the baseline cohort (64% racial/ethnic minority; mean age, 51.8±17.7 years; BMI, 26.2±5.4 kg/m ² ). At baseline, mean PSQI and ISI scores were 5.9±3.4 and 7.6±5.3, respectively; 18% were classified as high risk for OSA. Higher PSQI scores were associated with greater odds of HTN (OR=1.37; 95%CI=1.08, 1.81) and higher oDBP (β=0.84; P =0.044) and aDBP (β=0.84; P =0.027); however, the association with aDPB was attenuated after adjustment for menopausal status and PA. Poor sleep quality (PSQI score >5) was associated with higher oDBP (β=3.92; P =0.050) and aDBP (β=6.78; P =0.005). Higher ISI score was associated with higher aDBP (β=0.50; P =0.045) and greater odds of HTN (OR=1.17; 95%CI=1.02, 1.37), as well as higher oDBP in models not adjusted for PA (β=0.41; P =0.034). Compared with low OSA risk, high OSA risk was associated with higher oSBP (β=8.72; P =0.043) and oDBP (β=6.03; P =0.024). Sleep duration was not associated with any outcome. Conclusion: Poor sleep quality and disordered sleep were associated with higher BP and greater HTN risk approximately 10 years later among women. These findings extend prior research by demonstrating that multiple dimensions of sleep health may have long-term implications for CVD risk. Several associations persisted after adjustment for major confounders, including BMI, suggesting that sleep health may represent an independent and modifiable target for HTN prevention among women.