Protective role of weekend catch-up sleep on hypertension in adults with physical inactivity

Background Insufficient sleep and physical inactivity are prevalent risk factors for hypertension. While weekend catch-up sleep has been suggested to compensate for weekday sleep debt, evidence regarding its association with hypertension remains limited. Purpose We aimed to investigate the association between weekend catch-up sleep and hypertension, and to determine whether this relationship varies by physical activity levels, a potent protective factor against hypertension. Methods We analyzed 40,727 adults from the Korea National Health and Nutrition Examination Survey (2016 to 2023). Weekend catch-up sleep was defined as the difference between weekend and weekday sleep duration. Physical activity was classified as active or inactive. Weighted logistic regression with restricted cubic splines was used to estimate odds ratios for hypertension. Results In the overall population, weekend catch-up sleep was associated with reduced odds of hypertension (adjusted odds ratio 0.94, 95% confidence interval 0.88 to 0.997, p=0.041). When stratified by physical activity, the inactive group exhibited a U-shaped association with the lowest odds at approximately 1 to 2 hours of weekend catch-up sleep, whereas the active group showed no significant non-linear trend. Although the interaction between weekend catch-up sleep and physical activity was not statistically significant (p=0.75), weekend catch-up sleep was significantly associated with reduced odds of hypertension in the inactive group (adjusted odds ratio 0.93, 95% confidence interval 0.87 to 0.999, p=0.047), but not in the active group (adjusted odds ratio 0.93, 95% confidence interval 0.79 to 1.10, p=0.403). Conclusion Modest weekend catch-up sleep (approximately 2 hours) is associated with a lower prevalence of hypertension, exhibiting a U-shaped relationship specifically among physically inactive adults. While physical activity remains central to prevention, modest weekend sleep recovery may offer supplementary benefits for those with insufficient activity.