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Evidence-Based Pediatrics Web Site

Poor sleep quality is associated with elevated blood pressure in adolescents


  • In adolescents with no significant co-existing comorbidities, does decreased sleep quality compared to adequate sleep quality increase risk of prehypertension?

Clinical Bottom Lines

  1. In a group of healthy adolescents, there was an association of low sleep efficiency with increased risk of prehypertension. However, cross-sectional studies can only make associations; they can’t determine causality.

Summary of Key Evidence

1. Cross-sectional cohort analysis of 238 adolescents, ages 13-16.
2. Those with significant comorbidities were excluded: sleep apnea, narcolepsy, diabetes, sarcoidosis, CP.
3. Primary oucome was prehypertension (≥ 90th percentile for age, sex, and height), and secondary outcomes were elevated systolic BP & elevated diastolic BP.
4. Results revealed that adolescents with a sleep efficiency ≤ 85% were at a 3.5-fold increased odds of being prehypertensive or hypertensive. This association persisted after adjustment for sex, SES, and adiposity.
5. Short sleep duration was also associated with a 2.5-fold increase in the odds of prehypertension or hypertension. However, this association appears, in part, to be attributable to low sleep efficiency. This result was not statistically significant.
6. Limitations: sample size, sample bias, can only make an association (versus causality).

Additional Comments

  • This is a hot topic of research, with many studies analyzing the potential public health impact of improving sleep duration and/or sleep quality in children. Not only due to sleep’s potential association with hypertension, but also with obesity and other clinically significant health outcomes.


  1. Javaheri et al. “Sleep Quality and Elevated Blood Pressure in Adolescents” Circulation 2008; 118:1034-1040.

CAT Author: Megan Mickley, M.D.

CAT Appraisers: Kerry Mychaliska, M.D.

Date appraised: May 13, 2009

Last updated November 10, 2009
Department of Pediatrics and Communicable Diseases
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