# Hypertension and Racial/Ethnic Disparities in Sleep Outcomes among Adults in the 2011–2023 National Health and Nutrition Examination Survey

## TL;DR

This study finds that racial and ethnic minorities with hypertension in the U.S. experience worse sleep outcomes, increasing their cardiovascular health risks.

## Contribution

The study reveals that sleep disparities among racial/ethnic groups are more significant in adults with hypertension.

## Key findings

- Non-Hispanic Black and Asian adults with hypertension had higher odds of short sleep compared to non-Hispanic White adults.
- Poor sleep quality was more common among non-Hispanic Asian, Black, and Hispanic adults with hypertension.
- Excessive daytime sleepiness was less common among non-Hispanic Asian, Black, and Hispanic adults compared to non-Hispanic White adults.

## Abstract

Racial/ethnic disparities in sleep outcomes may compound cardiovascular health (CVH) risks, particularly among adults with hypertension (HTN). This study examines differences in sleep health across racial/ethnic groups, with a primary focus on adults with HTN.

We analyzed NHANES data (2011–2023) for adults aged ≥20 years. Sleep outcomes included daytime sleepiness (2015–2020), sleep duration (2011–2023), and sleep quality (2011–2020). HTN was defined as blood pressure ≥130/80 mmHg, self-reported diagnosis, or antihypertensive use. Regression models assessed associations between race/ethnicity and each sleep outcome, adjusting for relevant covariates. Analyses were stratified by HTN status to examine differences among adults with and without HTN. All models incorporated NHANES sampling weights and accounted for the complex survey design.

Among ~201.7 million US adults (mean age: 48.0 ± 17.1 years), 52.6% had HTN. Among adults with HTN, NH Black and NH Asian adults had higher odds of short sleep (<7 hours) compared to NH White adults (aOR: 1.86, 95% CI: 1.58–2.21; aOR: 1.58, 95% CI: 1.29–1.93). Odds of poor sleep quality were elevated in NH Asian (aOR: 2.45, 95% CI: 2.09–2.89), NH Black (aOR: 1.47, 95% CI: 1.29–1.67), and Mexican-American/Hispanic adults (aOR: 1.57, 95% CI: 1.34–1.83). In contrast, excessive daytime sleepiness was less common among NH Asian (aOR: 0.17, 95% CI: 0.11–0.25), NH Black (aOR: 0.49, 95% CI: 0.34–0.72), and Hispanic adults (aOR: 0.38, 95% CI: 0.27–0.53) than NH White adults.

Racial/ethnic disparities in sleep health are more pronounced among adults with HTN, compounding their overall cardiovascular health risk.

Graphical Abstract