Early Cardiovascular Dysfunction in Military Personnel with Chronic Sleep Restriction: Integrated Evaluation of Ambulatory Blood Pressure and Arterial Stiffness

Abstract

Background: Chronic sleep restriction and irregular duty schedules are common among military personnel and have been associated with increased cardiovascular risk. However, the earliest cardiovascular alterations preceding overt disease remain incompletely characterized. This study investigated whether chronic sleep disturbances are associated with abnormalities in ambulatory blood pressure regulation, circadian blood pressure profile, arterial stiffness, and central hemodynamics in active-duty military personnel.
Methods: This cross-sectional observational study included 1,327 active-duty male military personnel aged 19–46 years. Participants were classified into three groups according to objectively assessed sleep characteristics and duty schedules: adequate sleep (n=418), chronic sleep restriction (n=503), and disrupted duty schedule (n=406). Sleep was evaluated using 14-day wrist actigraphy, sleep diaries, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and STOP-BANG screening. Twenty-four-hour ambulatory blood pressure monitoring was performed to assess circadian blood pressure regulation, while arterial stiffness and central hemodynamics were evaluated using non-invasive pulse wave analysis.
Results: Participants with chronic sleep restriction and disrupted duty schedules demonstrated significantly higher 24-hour and nighttime systolic blood pressure than those with adequate sleep (all P<0.001). The prevalence of unfavorable circadian blood pressure phenotypes increased progressively from 26.3% in the adequate-sleep group to 52.7% and 71.7% in the chronic sleep restriction and disrupted duty schedule groups, respectively (P<0.001). Nocturnal systolic blood pressure decline decreased significantly across the groups (14.96±9.67%, 8.80±9.33%, and 4.82±9.26%; P<0.001), while systolic blood pressure load increased correspondingly (P<0.001). In contrast, aortic pulse wave velocity, augmentation index, and central systolic blood pressure did not differ significantly among the study groups.
Conclusions: Chronic sleep restriction and disrupted duty schedules were associated with early impairment of circadian blood pressure regulation in military personnel, characterized by elevated nighttime systolic blood pressure, attenuation of physiological nocturnal blood pressure decline, and a higher prevalence of unfavorable circadian blood pressure phenotypes. These findings suggest that abnormalities in circadian blood pressure regulation may represent earlier manifestations of cardiovascular dysfunction than detectable changes in arterial stiffness or central hemodynamics. Integrating objective sleep assessment with ambulatory blood pressure monitoring may facilitate earlier cardiovascular risk stratification in military populations.