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

Abstract

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