The association between habitual sleep metrics and blood pressure reactivity to sympathoexcitatory stimuli in premenopausal females

BACKGROUND: Sleep is an important factor for cardiovascular health, with habitual sleep duration and efficiency associated with blood pressure (BP) both at rest and during sympathoexcitatory stimuli. However, previous research has focused on males or utilized mixed-sex samples, limiting the extrapolation of these findings to female populations. Our aim was to examine the relationship between sleep duration and efficiency on BP responses to sympathoexcitatory stimuli in premenopausal females. We hypothesized that sleep duration and sleep efficiency (SE) would be inversely associated with BP reactivity during sympathoexcitatory stimuli. METHODS: 26 females (21±4yrs; body mass index: 23±3kg/m2) were recruited. Following a period of supine rest (>10min), participants performed a 3-min isometric handgrip (IHG) exercise bout at 30% of maximum voluntary contraction, followed by 3-min of post-exercise ischemia (PEI) via brachial cuff-occlusion at 240mmHg. Participants then rested for 15-min, after which they performed a cold pressor test (CPT) for up to 3-min. Beat-by-beat BP was measured throughout each test. Baseline BP was calculated as the average over a 5-min period prior to each test. Changes (Δ) in systolic (SBP) were determined from the final minute of IHG and PEI, and the final 30-s of the CPT. Average total sleep time (TST) and SE were assessed using wrist actigraphy monitors worn for 10 consecutive days. Associations between habitual sleep metrics, resting SBP, and ΔSBP during sympathoexcitatory tests were assessed using partial Pearson correlations controlling for sleep duration prior to testing. RESULTS: For all participants, BP (mmHg) at rest was 110±10 for SBP, 66±7 for diastolic BP, and 83±8 for mean arterial pressure. Additionally, habitual TST was 454±53min and SE was 91±4%. Due to missing data, sample sizes differed across sympathoexcitatory tests (IHG and CPT: n=26; PEI: n=24). Low SE was associated with greater SBP at rest (r=-0.434, P=0.030) and during the IHG (r=-0.405, P=0.045), but not PEI or CPT (P>0.05). TST was not associated with resting SBP (P>0.05). However, shorter TST was correlated with increased SBP reactivity during the CPT (r=-0.616, P=0.001). No association was observed between TST and SBP responses to IHG or PEI (P>0.05). CONCLUSION: These findings suggest that lower habitual SE is associated with higher SBP at rest and during exercise pressor reflex activation in premenopausal females. Additionally, shorter habitual TST was associated with increased SBP during general sympathetic activation. Collectively, these results underscore the multidimensional nature of sleep and suggest that distinct components of habitual sleep may impact BP regulatory reflexes in premenopausal females. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.