Abstract TU266: Impact of Sleep Health on Mortality with Blood Pressure Variability and Race as Modifiers

Abstract

Introduction: Multidimensional sleep health (MDSH) is an important but understudied determinant of mortality. We evaluated whether blood pressure variability (BPV) and race/ethnicity modify the association between MDSH and all-cause and cardiovascular mortality. Hypothesis: Poorer MDSH is associated with higher mortality, with stronger associations among individuals with high BPV and across race/ethnic groups. Methods: We analyzed NHANES 2005–2008 and 2015–2018 linked to mortality through 2020 in adults ≥20 y (n=10,279). MDSH (score 0-4) incorporated sleep duration, latency, disorder, and sleepiness. BPV was the SD of three BP readings, categorized into tertiles. Adjusted cox proportional hazard model assessed for associations of MDSH score with cardiovascular and all-cause mortality. Additional analyses further evaluated for effect modification by BPV tertiles or ethnicity. Results: Poorer MDSH was associated with higher all-cause mortality (HR 2.47, 95% CI 1.37–4.45, p=0.031 for 0–1 vs 4; HR 1.17 per unit decrease, 95% CI 1.07–1.29, p=0.001). Sleepiness showed the strongest association with cardiovascular mortality (HR 1.71, 95% CI 1.12–2.61, p=0.014). BPV modified associations, with poor MDSH linked to increased all-cause mortality in the high BPV group (HR 3.02, 95% CI 1.07–8.53, p=0.038). Race/ethnicity modified associations: Non-Hispanic Black adults had elevated cardiovascular risk with moderate MDSH (HR 2.17, 95% CI 1.06–4.46, p=0.035), while Hispanic adults had lower risk with poor MDSH (HR 0.25, 95% CI 0.08–0.75, p=0.015). Conclusions: Poorer MDSH, especially sleepiness, is associated with higher all-cause mortality. BPV amplifies risk among those with high variability, and race/ethnicity modifies these associations. Improving sleep health may help reduce mortality, particularly in racially diverse populations with unstable BP.