Adults with excessive daytime sleepiness (EDS) who also take 30 minutes or longer to fall asleep have more than triple the risk of developing hypertension compared to those without either symptom, new research suggests.

In a large observational cohort study, adults reporting EDS had 52% higher odds of prevalent hypertension and 74% higher odds of incident hypertension than their counterparts without EDS.

Participants with both EDS and prolonged sleep-onset latency had more than double the odds of prevalent hypertension and more than triple the odds of incident hypertension compared with those who had neither condition.

Although EDS alone was associated with increased hypertension risk, the combination of EDS and prolonged sleep-onset latency identified a “distinct subgroup” at substantially greater risk, study investigator Alexandros N. Vgontzas, MD, professor of psychiatry and behavioral health and director of the Sleep Research and Treatment Center at Penn State College of Medicine, Hershey, Pennsylvania, told Medscape Medical News. 

“The greatest risk for high blood pressure is among those who feel sleepy and tired during the day and also have difficulty initiating sleep,” he added.

The study was presented on June 17 at SLEEP 2026.

Distinct High-Risk Phenotype

The analysis drew on data from more than 1700 adults participating in the Penn State Adult Cohort, a population-based longitudinal study of sleep and health in adults. 

Incident hypertension analyses included 786 participants without hypertension at baseline who were followed for an average of 7.5 years. All participants underwent an overnight sleep assessment using polysomnography.

EDS was defined by self-reported moderate-to-severe daytime sleepiness and/or irresistible sleep attacks. Prolonged sleep-onset latency of 30 minutes or more served as an objective index of sleep disturbance/hyperarousal. Hypertension was defined as a systolic blood pressure (BP) of at least 140 mm Hg, a diastolic BP of at least 90 mm Hg, or antihypertensive treatment. 

Compared with controls without EDS or prolonged sleep-onset latency, adults reporting EDS had higher odds of both prevalent (odds ratio [OR], 1.52) and incident hypertension (OR, 1.74), after adjusting for multiple potential confounding factors. 

The combination of EDS and prolonged sleep-onset latency conferred more than a twofold increase in prevalent hypertension (OR, 2.34) and more than a threefold increase in incident hypertension during follow-up (OR, 3.43).

Vgontzas said the results may reflect a state of “physiological and possibly emotional hyperarousal” in which the body’s stress systems remain activated despite feelings of fatigue. Previous research from his group suggests increased activation of stress pathways, including the hypothalamic-pituitary-adrenal axis and cortisol secretion, among these patients.

Recognizing the combined phenotype of EDS plus prolonged sleep-onset latency may have implications for clinical diagnosis and treatment planning.

“These findings suggest that evaluating excessive daytime sleepiness should extend beyond screening for sleep apnea alone,” Vgontzas said in a statement. “Assessing nighttime sleep difficulties and objective sleep measures such as prolonged sleep-onset latency may help identify patients with elevated cardiovascular risk and support more targeted treatment approaches,” he added. 

Notably, adults with both EDS and prolonged sleep-onset latency were also significantly more likely to have insomnia and depression than controls. 

“When you have someone whose complaints are sleepiness and tiredness, don’t just think sleep apnea. Look at the entire picture and also check if they suffer from insomnia or depression. You may want to treat what disturbs their night’s sleep and what makes it difficult for them to fall asleep,” he said.

Such interventions could include behavioral approaches, treatment of coexisting depression, or pharmacologic therapies aimed at improving sleep initiation and sleep quality, he noted.

The Sleep-Heart Connection

The findings are biologically plausible and align with what sleep specialists observe in clinical practice, said Michael Breus, PhD, a clinical psychologist and founder of TheSleepDoctor.com, who was not involved in the study. 

Breus pointed to undiagnosed sleep apnea as one potential contributor but emphasized that sleep and cardiovascular health are deeply interconnected.

“Most people think of sleep as a neurologic event, and I would argue that it’s probably half cardiopulmonary, half neurology,” Breus said.

“If our heart’s not doing the things that it needs to do and recovering during sleep, it becomes problematic,” he added. “When you’ve got people who’ve got cardiac issues, it shouldn’t be a particularly big surprise that they have sleep issues — and vice versa.”

Breus agreed that the findings reinforce the importance of screening for sleep disorders, particularly sleep apnea and insomnia, in patients with hypertension and other cardiovascular conditions.

The study received no commercial funding. Vgontzas and Breus had no relevant disclosures.