Gender differences in sleep quality and its associated factors in patients with hypertension: a cross-sectional study

Introduction: In Malaysia, one third of the adult population suffer from hypertension and literature reported poor sleep quality led to cardiovascular events. However, little study was conducted to look at the gender-specific differences in sleep quality among hypertensive patients. This study aimed to examine gender difference in sleep quality and its associated factors among hypertensive population in a primary care clinic. Method: This was a cross-sectional study conducted from December 2023 to February 2024 using systematic approach with validated questionnaires (PSQI, DASS-21, STOP-BANG). Multiple logistic regression and Firth’s penalized regression (to address sparse data/complete separation) were used to identify the determinants of poor sleep among different gender hypertensive patients. Results: Three hundred thirty-five participants (62.9% female, mean age 58 years) were recruited in this study. Prevalence of poor sleep among male and female were 91.1% and 84.8% respectively. In the multivariable analysis for men, a lack of regular physical exercise (< 150 min/week) was identified as the sole significant predictor of poor sleep (aOR 6.278, p = 0.040). Among women, poor sleep was significantly associated with anxiety symptoms (aOR 11.486; 95% CI: 1.37–96.21; p = 0.024) and income, where those in the B40 (bottom 40% income) and T20 (top 20% income) groups had higher odds of poor sleep compared to the M40 group (aOR 3.46; 95% CI: 1.23–9.72; p = 0.019). Conclusion: These findings highlight gender-specific determinants of sleep disturbances among those with hypertension, suggesting tailored interventions addressing physical inactivity for men and socioeconomic support or anxiety management for women to improve sleep quality.

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