0992 Quantifying Direct and Indirect Pathways Linking Poor Sleep Health to Hypertension Risk

Abstract Introduction Poor sleep health may increase hypertension risk directly through, for instance, non-dipping and indirectly by exacerbating other modifiable, more traditional risk factors such as physical inactivity and consumption of alcohol along with an unhealthy eating pattern. However, the indirect contribution of these lifestyle medicine pillars remains poorly quantified, although quantification can help identify targets offering the most harm reduction. Methods Using longitudinal data from the Sister Study (enrollment [2003-2009] to follow-up [2018-2019]), we assessed self-reported dimensions of poor sleep health (short sleep duration, irregularity, sleep debt, frequent napping, insomnia symptoms, and a cumulative poor sleep score) and other lifestyle medicine pillars (smoking, alcohol consumption, physical activity, diet, and stress) at enrollment. Participants reported physician-diagnosed incident hypertension over a median 11-years of follow-up. Cox proportional hazards models both estimated hazard ratios (HRs) and 95% confidence intervals (CIs) and assessed the indirect effects of sleep characteristics on hypertension via individual lifestyle medicine pillars and via all pillars simultaneously. Results Among 25,825 women (mean age: 53.8 years [SD=8.9]) without hypertension at enrollment, 7,547 developed hypertension. All sleep dimensions were associated with hypertension risk, ranging from a 6% higher risk (HR=1.06; 95% CI: 1.00-1.12) for sleep debt to a 16% higher risk (HR=1.16; 95% CI: 1.10-1.22) for insomnia symptoms. Further, former smoking, current smoking, physical inactivity, and unhealthy diet were significant single mediators for most associations between unfavorable sleep characteristics and hypertension. Alcohol consumption and stress did not mediate associations. Simultaneous lifestyle pillars collectively explained 12% (95% CI: 2%-29% for short sleep) to 34% (95% CI: 17%-156% for sleep debt) of the associations with unhealthy diet explaining the most (up to 13% [95% CI: 5%-69%]) while current smoking explained the least (up to 6% [95% CI: 2%-20%]). Conclusion Poor sleep health in relation to hypertension risk may be partly explained by other lifestyle medicine pillars among US women. Multifactorial and multi-component interventions targeting smoking, physical activity, and diet along with multiple dimensions of sleep may more effectively aid in reducing the burden of hypertension among U.S. women while pathways involving alcohol use and stress require further study. Support (if any)