Adolescents with a short sleep duration, whether with or without insomnia, may be at an increased risk of elevated blood pressure (BP) than those with a normal sleep duration, according to a study presented at the EPI|Lifestyle Scientific Sessions 2025.

“We know that disturbed and insufficient sleep was associated with high BP in adults, particularly in adults who report insomnia and sleep objectively <6 hours, but we do not yet know if these associations exist in adolescents,” said study author Professor Julio Fernandez-Mendoza from the Pennsylvania State University College of Medicine in Hershey, Pennsylvania, US.

Hence, the researchers conducted a population-based study of randomly selected 421 adolescents (median age 16.5 years, 54 percent boys) from the Penn State Child Cohort who underwent 9-hour polysomnography (PSG) and physical examinations to assess the associations between sleep duration and BP levels. [EPI|Lifestyle Scientific Sessions 2025, abstract MP13]

BP levels were measured three consecutive times in a seated position, with the average of the last two measurements used to determine the systolic and diastolic levels. Elevated BP was defined as systolic ≥120 mm Hg and diastolic <80 mm Hg, while stage 2 hypertension was defined as systolic ≥140 mm Hg or diastolic ≥90 mm Hg.

PSG was used to assess sleep duration, which was divided into four groups: normal sleep duration (n=126 [reference group]), short sleep duration (n=136), insomnia with normal sleep duration (n=82), and insomnia with short sleep duration (n=77).

Compared with individuals with a normal sleep duration (≥7.7 hours), those with a short sleep duration (<7.7 hours) had a 2.7-fold higher risk of elevated BP (odds ratio [OR], 2.7; p=0.001).

In addition, individuals with insomnia and short sleep duration were five times more likely to develop stage 2 hypertension than those with a normal sleep duration (OR, 5.0; p=0.041). “We know that stage 2 hypertension is clearly a cardiovascular (CV) risk factor,” said Fernandez-Mendoza, “so these kids are left at risk of developing CV disease if it is not treated.”

“Taken together, insomnia with short sleep duration in adolescents was associated with stage 2 hypertension, while short sleep duration without insomnia was associated with incipient elevated BP,” said the researchers. “These findings further support that insomnia with short sleep duration is a more biologically severe phenotype of insomnia. This insomnia phenotype may require different therapeutic approaches.”

Insomnia with normal sleep

Participants with self-reported insomnia but had a normal sleep duration did not appear to be at an increased risk of elevated BP (OR, 1.5; p=0.2999) or stage 2 hypertension (OR, 1.0; p=0.997).

“These data can help alleviate worries and concerns in youth and their parents that not all youth with insomnia are at risk for CV problems and that the best approach is to always pay attention to the sleep complaints of the teen,” said Fernandez-Mendoza.

“While we need to explore this association in larger studies on teens, it is safe to say that sleep health matters for heart health, and we should not wait until adulthood to address it,” he noted. “Not all teens who complain of insomnia symptoms are at risk for CV issues. However, monitoring their sleep duration objectively can help us identify those who have a more severe form of insomnia and are at-risk for heart problems.”