The Role of Body Mass Index and Obesity Indicators in Sleep Quality Among Hypertensive Patients in Turkey

Neslişah Gürel Köksal,1 Mustafa Köksal2 1Department of Family Medicine, Giresun University Training and Research Hospital, Giresun, Turkey; 2Department of Public Hospital Services, Giresun Provincial Directorate of Health, Giresun, TurkeyCorrespondence: Neslişah Gürel Köksal, Department of Family Medicine, Giresun University Training and Research Hospital, 145 Mehmet İzmen Street, Giresun, 28100, Turkey, Tel +90 539 503 7091, Email [email protected]: Hypertension carries a substantial public health burden, and obesity and sleep disturbances are bidirectionally linked; however, their combined impact remains underexamined among hypertensive adults in Turkey. We aimed to estimate the prevalence of obesity in a primary care sample of Turkish adults with hypertension and to evaluate associations between multiple anthropometric indicators (BMI, waist circumference, neck circumference, and waist-to-height ratio [WHtR]) and sleep quality.Methods: The sample of this cross-sectional, descriptive, analytical study consisted of 124 individuals who applied to Giresun Training and Research Hospital Family Medicine Polyclinics between November 2024 and February 2025 and were diagnosed with hypertension. Research data were collected face-to-face using a sociodemographic survey and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results: The mean age of participants (63.7% female) was 52.8 ± 8.06 years. The mean time since hypertension diagnosis was 9.27 ± 6.25 years; the prevalence of obesity was 51.6%, and 42.7% had poor sleep quality. In univariate analyses, higher BMI was associated with poor sleep quality (OR = 1.081; p = 0.025); however, this association was not retained in the multivariable model (p = 0.122). Other anthropometric parameters (eg, waist circumference, WHtR, neck circumference) and blood pressure values were not significantly associated with sleep quality.Conclusion: Among hypertensive individuals managed in primary care, obesity and poor sleep quality are prevalent and should be addressed together. The waist-to-height ratio (WHtR) is a practical secondary indicator, and regular physical activity along with healthy sleep habits may support hypertension control.Plain Language Summary: People with high blood pressure often also have obesity and poor sleep, which can make blood pressure harder to control. This study explored how obesity-related body measurements, including body mass index (BMI) and waist-to-height ratio (WHtR), are linked to sleep quality in adults with hypertension in Turkey. A total of 124 patients receiving primary care completed questionnaires about their lifestyle and sleep habits. About half of the participants were obese, and 43% had poor sleep quality. Those with higher BMI were more likely to experience poor sleep, while other body measurements were not significantly related. These results show that obesity and low physical activity may worsen sleep and overall health in people with hypertension, underlining the importance of lifestyle changes such as healthy diet, regular exercise, and weight control for better management of both sleep and blood pressure.Keywords: hypertension, obesity, anthropometry, sleep quality, cross-sectional studies