The Relationship Between Sleep Quality and Blood Pressure in Elderly Hypertensive Patients

The Relationship Between Sleep Quality and Blood Pressure in Elderly Hypertensive Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship Between Sleep Quality and Blood Pressure in Elderly Hypertensive Patients Vildan Kocatepe, Havva Nur Poyraz, Selin Nemutlu, Banu Balım, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7544584/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Geriatrics → Version 1 posted 14 You are reading this latest preprint version Abstract Aim: Therefore, this study was conducted to examine the relationship between sleep quality and blood pressure in elderly hypertensive patients. Methods: This study was conducted using a descriptive, correlational, and cross-sectional design. The sample consisted of 200 patients over the age of 65 who were diagnosed with hypertension and hospitalized in the internal medicine clinic of a training and research hospital between October 2023 and June 2024. The Patient Identification Form and the Richard Campbell Sleep Quality Scale were used to obtain the data. Results: The mean age of the elderly patients participating in the study was 76.36 ± 7.70 years, and the average duration of hypertension was 15.63 ± 9.61 years. The mean daytime sleep duration of the patients was found to be 61.63 ± 32.31 minutes. A total of 28% of the elderly patients reported having a regular sleep habit. The mean score of the Richards Campbell Sleep Quality Scale (RCSQ) was 54.45 ± 17.23. There was a statistically significant difference in RCSQ sleep quality scores based on sleep habits (t=5.866; p<0.01), sleep duration before hospitalization (F=61.281; p=0.00), ability to sleep at the desired time in the hospital (U=4.796; p=0.00), and nighttime awakenings (U=-6.086; p=0.00). Ability to sleep at desired time in the hospital (yes) increases the sleep quality score by 0.299 times, sleep habit (regular) 0.318 times and nighttime sleep duration before hospitalization (9 hours and over) 0.167 times. Conclusion: The findings regarding the effects of daytime sleep on vital signs indicate that elderly patients who take daytime naps have lower systolic and diastolic blood pressure compared to those who do not. Elderly Hypertension Sleep Quality Vital Signs Daytime Sleepiness Introduction Hypertension (HT) affects 1.28 billion adults aged 30 to 79 worldwide, with two-thirds of these individuals living in low- and middle-income countries [1]. Although the definition of hypertension does not vary by age group, HT is more common in elderly individuals. The prevalence of HT is higher in people over the age of 65, making it a significant health concern for this age group [2]. The increase in life expectancy has significantly raised the percentage of individuals aged 65 and older in both developed and developing countries. Projections indicate that by 2050, 20% of the world’s population will be aged 65 and above [3]. Short sleep duration is a major risk factor for the development of hypertension. It has been found that older adults stay in bed longer but sleep less compared to younger individuals [4, 5]. Hypertension is associated with poor sleep quality and decreased sleep efficiency [6]. Another factor that increases the risk of hypertension is the increase in daytime sleep due to reduced nighttime sleep duration, which is observed in a significant portion of elderly patients [7]. A study conducted in the United States found that 44.7% of individuals with hypertension had sleep disorders, 31.7% had short sleep duration, and 30.3% had poor sleep quality [8]. Similarly, a study conducted in Brazil reported poor sleep quality among hypertensive individuals [9]. One of the reasons for the poor prognosis of hypertension is low sleep quality [10]. A study in China also reported that individuals with good sleep quality had significantly lower systolic and diastolic blood pressure levels compared to those with poor sleep quality. Additionally, the prevalence of hypertension was significantly higher among individuals with poor sleep quality, which was found to increase both systolic and diastolic blood pressure .[11] Sleep is an important parameter for enhancing quality of life and maintaining overall well-being [12]. It is a fundamental physiological necessity, essential for human survival [13]. A study reported that different stages of sleep could lead to increases in blood pressure [14]. It has been found that older adults stay in bed longer but sleep less compared to younger individuals [4, 5]. A study conducted in Turkey revealed that hypertensive patients with good sleep quality had significantly higher blood pressure control rates than those with poor sleep quality [6]. These findings suggest that elevated blood pressure may contribute to various symptoms that impair sleep quality, or conversely, poor sleep quality may lead to increased blood pressure. Furthermore, while daytime sleep has known benefits, frequent daytime napping—especially among older adults—has been reported to be associated with hypertension [15, 16]. Nurses play a critical role in identifying, interpreting, and managing insomnia in patients. Both subjective data from the patient and objective assessment methods can be used to evaluate sleep duration and quality. Many patients do not inform healthcare professionals about their sleep issues; therefore, it is essential to regularly ask all patients about their sleep patterns. A sleep history should include factors such as the duration of sleep, sleep routine, and daytime alertness [17]. Nurses must also take a multifaceted approach to hypertension management. They should guide patients in areas such as diagnosis, medication monitoring, patient education, counseling, and skill development. In particular, patient education is crucial in improving treatment adherence and positively influencing the course of the disease [18]. For nurses, it is important to first identify these issues and determine the relationship between sleep quality and hypertension in elderly individuals, as they play a significant role in managing insomnia and maintaining blood pressure control. A literature review found limited studies examining the relationship between sleep and hypertension [6, 8, 9, 11]. Among studies focusing on older adults, only research investigating the effects of daytime sleep on hypertension was found [15]. Therefore, this study was conducted to examine the relationship between sleep quality and blood pressure in elderly hypertensive patients. Methods Study Design This study was conducted using a descriptive, correlational, and cross-sectional design. Population The population of the study consisted of all patients hospitalized in the internal medicine clinic of a training and research hospital between October 2023 and June 2024 who met the inclusion criteria. The sample included patients who: were aged 65 years and older, had a diagnosis of hypertension; patients were excluded from the study if they: had a neurological diagnosis affecting cognitive function (e.g., dementia, Alzheimer's), had a psychiatric disorder affecting sleep quality (e.g., insomnia), lacked orientation to time, place, or person, had hearing or speech impairments,were using sleep medication. The sample size was calcu-lated using the G*Power 3.1.9.7 programme based on the formula of the sample with infinite population. The sample size was foundto be at least 169 patients at the effect size of 0.3, an error margin of 0.05 and a power level of 95%. Considering the possibility ofwithdrawal from the study and missing data, a total of 200 patientswere included in the sample. When the required sample size forthe study was reached, the data collection process was completed. Data Collection Data were collected using a face-to-face method. The Patient Diagnosis Form and the Richard Campbell Sleep Quality Scale were used to obtain the data. It took approximately 15-20 minutes for the patients to complete the data collection forms. The patients' vital signs were measured and recorded by the researchers. Descriptive Characteristics Form The form was developed by the researchers based on the literatüre [6, 8, 9, 11, 14]. The form consists of a total of 30 questions divided into the following sections: Personal Characteristics: Includes five questions regarding gender, age, marital status, education level, and employment status. Disease-Related Characteristics: Includes five questions regarding chronic disease status and medications. Sleep Habits Characteristics: Includes 16 questions exploring sleep habits, sleep problems, daytime sleep duration, sleep patterns in the hospital, and sleep education. Blood Pressure-Related Characteristics: Includes four questions related to blood pressure. To assess the effect of daytime sleep on blood pressure, blood pressure readings were taken from the patients at two different times: in the morning and in the afternoon. Richards Campbell Sleep Quality Scale (RCSQ) The Richards Campbell Sleep Quality Scale (RCSQ) was developed by Richards in 1987 as a diagnostic tool to assess sleep quality in patients receiving care in critical care settings [19]. The scale evaluates various aspects of a patient's nighttime sleep, including the depth of sleep, time taken to fall asleep, frequency of awakenings, duration of wakefulness after waking up, overall sleep quality, and the level of noise in the environment. Each item is assessed by the patient using a 0-100 visual analog scale to query their nighttime sleep experience. In the validity and reliability study conducted by Richards, the Cronbach's α value of the scale was reported to be 0.82 [19]. The Turkish validity and reliability of the scale were performed by Karaman Özlü and Özer in 2015, with the Cronbach's α value reported as 0.91 [20]. Data Analysis All collected data were transferred to the SPSS software for analysis. For the analysis of data related to personal characteristics, disease-related characteristics, sleep habits, and blood pressure characteristics, frequency, percentage, mean, median, and standard deviation were used. Based on the results of the normality test, for normally distributed measurements, the independent t-test was used to compare two groups, one-way ANOVA was used for comparing multiple groups, and Pearson correlation analysis was conducted for relational inferences. For non-normally distributed measurements, the Mann-Whitney U test was used for comparing two groups, the Kruskal-Wallis test was used for comparing multiple groups, and Spearman correlation analysis was used for relational inferences. A statistical significance level of 0.05 was used for all analyses. Ethics approval and consent to participate The study was approved by the XXX Demokrasi University Non-Interventional Research Ethics Committee (decision number 2023/67- 14.06.2023). Informed consent was obtained from all individual participants included in the study. The research was conducted in accordance with the Declaration of Helsinki. Findings The average age of the patients participating in the study was 76.36 ± 7.70 years, and the average duration of hypertension was 15.63 ± 9.61 years. 54.5% of the participants were women. 55% of the patients were married. Regarding education, 15% of the participants were illiterate, 69.5% had primary education, 14% had secondary education, and 1.5% had a bachelor's degree or higher. 98% of the patients were not employed. The presence of comorbidities in the participants was 84%, with the following conditions observed: Diabetes Mellitus in 60.5%, Coronary Heart Disease-Heart Failure in 38%, Chronic Obstructive Pulmonary Disease in 12.5%, Chronic Kidney Failure in 12.5%, and Cancer in 8%. 98% of the patients reported that their medication dose had not been increased in the past year, and 92% indicated that their medication had not been changed in the past year (Table 1). The average daytime sleep duration of the patients was 61.63 ± 32.31 hours. 28% of the elderly patients reported having a regular sleep habit. Before being admitted to the hospital, 55.5% of the participants reported sleeping 4-5 hours, 40.5% reported 6-8 hours, and 4% reported 9 hours or more. 70.5% of the patients stated that they napped before being hospitalized, while 57.5% answered "no" regarding napping today. Regarding changes in sleep patterns after hospitalization, 76% of the patients responded "no" to experiencing changes. Among those who reported negative changes, 6% indicated "I had difficulty falling asleep," 7% indicated "I started waking up frequently," 0.5% indicated "I started waking up very early," 3.5% indicated "My nighttime sleep duration decreased," 1% indicated "I started having insomnia complaints at night," 1% indicated "I started feeling like I hadn't slept at all when I woke up in the morning," and 2% indicated "My bedtime changed." Regarding positive changes after hospitalization, 10% of patients reported "I started falling asleep more easily," 1% reported "I started feeling more rested in the morning," and 1% reported "My bedtime became regular." 89% of the patients stated that they could sleep at their desired time in the hospital. 88.5% of the patients answered "yes" to waking up during the night, with 5.5% waking up once, 27% waking up twice, and 58.5% waking up three or more times. 77% of the patients reported napping during the day in the hospital. 78.5% of the patients indicated that the person they communicated their sleep problem to was the nurse. 100% of the patients did not take sleep aids, and 100% did not receive sleep education as part of their hypertension treatment. 70.5% of the patients answered "yes" to napping during the day (Table 2). The average score of the patients on the Richards Campbell Sleep Quality Scale (RCSQ) was found to be 54.45 ± 17.23. There was no statistically significant difference in RCSQ sleep quality scores according to gender, marital status, comorbidity, daytime napping, and changes in sleep patterns after hospitalization. However, statistically significant differences were found in RCSQ sleep quality scores according to the patients' sleep habits (t=5.866; p<0.01), sleep duration before hospitalization (F=61.281; p=0.00), ability to sleep at their desired time in the hospital (U=4.796; p=0.00), and night waking occurrences (U=-6.086; p=0.00) (Table 3). A statistically significant difference was found in the afternoon (16:00) systolic blood pressures of patients according to their daytime napping status (t=-2.804 / p=0.005). A statistically significant difference was also found in the afternoon diastolic blood pressures of patients based on their daytime napping status (t=-2.316 / p=0.022). Among patients who napped during the day, a statistically significant difference was found between their morning and afternoon systolic blood pressures (t=4.569; p˂0.001) (Table 4). No statistically significant correlation found between the patients' daytime sleep duration and their vital signs. A moderate, negative statistically significant relationship was found between the RCSQ sleep quality scores and the morning heart rate (r= -0.49; p=-0.171). Apart from the morning heart rate, no statistically significant correlation was found between the sleep quality scores and other vital signs. Considering the analysis results, the model established was statistically significant (F = 16.078, p<0.001). The model including gender, ability to sleep at desired time in the hospital, sleep habit and nighttime sleep duration before hospitalization variables were found to be statistically significant, explaining 24.8% of the variance in the RCSQ Total Score (p<0.05). According to the standardised regression coefficient (β), ability to sleep at desired time in the hospital (yes) (β=0.299), Sleep Habit (regular) (β=0.318) and nighttime sleep duration before hospitalization (9 hours and over) (β=0.167) were found to affect the RCSQ Total Score. Ability to sleep at desired time in the hospital (yes) increases the sleep quality score by 0.299 times, sleep habit (regular) 0.318 times and nighttime sleep duration before hospitalization (9 hours and over) 0.167 times. Table 5 presents the results. Discussion This study emphasizes the importance of daytime naps and sleep quality in elderly hypertensive patients and highlights the need for nurses to play a more active role in improving sleep quality. One of the most important findings in this study is that the average daytime sleep duration of the patients was 61.63 ± 32.31 minutes. This duration is quite long and is consistent with the literature suggesting that long daytime sleep can increase the risk of hypertension in older individuals [15, 16]. Only 28% of the patients reported having a regular sleep habit. Irregular sleep patterns may complicate the control of hypertension [8, 9] . Furthermore, in terms of sleep duration, 55.5% of the patients slept for 4-5 hours, 40.5% for 6-8 hours, and 4% for 9 hours or more. According to the literature, sleeping less than 6 hours is a significant risk factor for hypertension [11]. These findings support the literature on the importance of sleep duration and quality in the management of hypertension. The factors negatively affecting the patients' sleep quality include their existing irregular sleep habits and the fact that their sleep duration before hospitalization was 4-5 hours. On the other hand, the ability to sleep at their desired time in the hospital has a positive impact on their sleep quality. Furthermore, although most of our patients experienced an increase in nighttime awakenings after hospitalization, 76% of them reported that there was no change in their sleep pattern in the hospital. This suggests that patients may not be aware of the impact that nighttime sleep fragmentation could have on their hypertension. The frequent nighttime awakenings of patients is a significant factor that greatly reduces sleep quality. The finding of a meaningful difference between nighttime awakenings and sleep quality in this study underscores the importance of sleep fragmentation in the management of hypertension. The literature suggests that frequent nighttime awakenings are common in patients with hypertension and negatively impact blood pressure regulation [14]. The literature clearly highlights the impact of sleep problems on the prevalence of hypertension. In a study examining the effects of sleep quality on hypertension, it was found that shorter sleep duration and self-reported sleep problems were each associated with an increased risk of hypertension. Additionally, a positive relationship was identified between poor sleep patterns and the risk of hypertension [21]. A study examining the relationship between sleep duration, sleep quality, and hypertension prevalence in individuals aged 65 and older found that as sleep quality decreased, the risk of hypertension increased. Additionally, the study indicated a "U" shaped relationship between sleep duration and hypertension risk, suggesting that both short and long sleep durations are associated with an increased risk of hypertension [22]. The majority of patients reported having a sleep duration of 4-5 hours before hospitalization, with daytime sleep durations exceeding 60 minutes on average. However, most patients stated that there was no change in their sleep patterns after being admitted to the hospital. Despite this, our results indicate an increase in both nighttime awakenings and daytime sleep frequency following hospitalization. In terms of the impact of daytime sleep on vital signs, the results show that patients who napped during the day had lower systolic and diastolic blood pressures compared to those who did not nap. To date, there have been no studies examining the relationship between daytime sleep and vital signs in hospitalized patients. However, most community-based studies exploring the relationship between daytime sleep and hypertension have primarily focused on the Chinese population [23–25]. The relationship between daytime sleep and hypertension is still not fully understood. One study has suggested that daytime sleep may provide cardiovascular benefits by reducing psychological stress [26]. The results of a study conducted by Huang and colleagues showed that daytime sleep lasting more than 60 minutes significantly reduced the prevalence of hypertension. Additionally, this protective effect was found to be effective in individuals who also had an appropriate nighttime sleep duration of 7-8 hours [27]. Cai and colleagues demonstrated that napping (siesta) is associated with a reduction in the prevalence of hypertension among older adults in China [25]. Zhao and colleagues have stated that populations with a daytime sleep habit have a lower prevalence of hypertension compared to those who do not nap at all [24]. In the present study, it was observed that patients who took daytime naps had lower both systolic and diastolic blood pressure. Additionally, the literature suggests that prolonged daytime naps, particularly in women (>60 minutes), are associated with a reduced prevalence of hypertension [28]. The most recent study reflecting the Chinese population suggests that long daytime naps (>30 minutes) could be an independent risk factor for the first ischemic stroke in hypertensive individuals. It also indicates that the optimal duration of daytime naps for hypertensive individuals should be 30 minutes or less, highlighting the potential risks associated with prolonged naps in this group [23]. This study is the first to explore the impact of daytime naps on vital signs in hypertensive patients in our country. The observed decrease in both diastolic and systolic blood pressure with an average one-hour daytime nap in patients can be attributed to a physiological effect related to the rest and relaxation experienced during the nap. Conclusion This study emphasises the importance of daytime sleep and patient sleep quality on vital signs in elderly hypertensive patients and shows that nurses should take a more active role to improve sleep quality. The study found that 77% of patients took daytime naps, with an average nap duration of approximately one hour. The results regarding the effect of daytime naps on vital signs show that patients who took naps had lower systolic and diastolic blood pressure compared to those who did not. The decrease in both diastolic and systolic blood pressure with an average one-hour nap in patients can be attributed to a physiological effect related to rest. The findings once again confirm that sleep quality is a crucial parameter in hypertension management. Regulating sleep habits, reducing nighttime awakenings, and optimizing sleep duration can improve sleep quality. Based on these results, nurses should individually assess sleep patterns and duration in patients and provide education on sleep hygiene. Moreover, the duration of daytime naps should be monitored. Nurses should inquire about sleep patterns in hypertension management and provide necessary guidance. LIMITATIONS This study is single-center, so its findings may not be generalizable to all elderly hypertensive patients. The data on sleep duration and sleep quality were based on patient self-reports, which can introduce a risk of bias. Since objective assessment methods (such as polysomnography or actigraphy) were not used, the measurements may have been subjective. Future studies can be designed with these objective methods for more accurate data collection. Additionally, psychosocial factors (stress, depression, anxiety) and other factors that may affect hypertension and sleep quality, such as patients' nutritional habits and physical activity levels, could not be standardized, and may have influenced sleep quality. These limitations should be considered when interpreting the study results. Declarations Ethics approval and consent to participate The study was approved by the Izmir Demokrasi University Non-Interventional Research Ethics Committee (decision number 2023/67- 14.06.2023). Informed consent was obtained from all individual participants included in the study. The research was conducted in accordance with the Declaration of Helsinki. Trial Registration Number: This study is not a clinical trial; therefore, registration was not required. Consent for publication Not applicable. Availability of data and material The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request Competing interests All authors have confrmed that they have no conficts of interest to disclose. Funding: This study was supported and funded by The Scientific and Technological Research Council of Turkey (TUBITAK, Project No: 1919B012302178). References World Health Organization (WHO). Hypertension. 2023. 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Personal and Disease-Related Characteristics (n=200) Mean ± SD Age 76.36± 7.70 Hypertension Duration 15.63± 9.61 Number (n) Percentage (%) Gender Female 109 54.5 Male 91 45.5 Marital Status Married 110 55 Single 90 45 Education Status Illiterate 30 15 Primary Education 139 69.5 Secondary Education 28 14 Bachelor's Degree and above 3 1.5 Employment status Yes 4 2 No 196 98 Comorbidity Yes 168 84 No 32 16 Comorbid Disease (n=168) Diabetes Mellitus 121 60.5 Coronary Heart Disease-Heart Failure 76 38 Chronic Obstructive Pulmonary Disease 25 12.5 Chronic Kidney Failure 25 12.5 Cancer 16 8 Increase in medication dosage in the last year Yes 4 2 No 196 98 Change in medication in the last year Yes 16 8 No 184 92 Table 2. Characteristics of Patients Related to Sleep (n=200) Mean ± SD Daytime Sleep Duration (minute) 61.63± 32.31 Number (n) Percentage (%) Sleep Habit Regular 56 28 Irregular 144 72 Nighttime Sleep Duration Before Hospitalization 4-5 hours 111 55.5 6-8 hours 81 40.5 9 hours or more 8 4 Daytime Sleep Before Hospitalization Yes 141 70.5 No 59 29.5 Daytime Sleep Status Today Yes 85 42.5 No 115 57.5 Change in Sleep Pattern After Hospitalization Yes 48 24 No 152 76 Changes in Sleep Pattern After Hospitalization (Negative) I had difficulty falling asleep 12 6 I started waking up frequently 14 7 I began waking up very early in the morning 1 0.5 My nighttime sleep duration decreased 7 3.5 I began feeling like I hadn’t slept at all when I woke up in the morning 2 1 Started insomnia at night 2 1 My bedtime changed at night 4 2 Changes in Sleep Pattern After Hospitalization (Positive) I started sleeping more comfortably 20 10 I began feeling more rested when I woke up 2 1 My bedtime became more regular 2 1 Ability to Sleep at Desired Time in the Hospital Yes 178 89 No 22 11 Waking Up During the Night in the Hospital Yes 177 88.5 No 23 11.5 If yes; how many times? Once 11 5.5 Twice 54 27 Three or more times 117 58.5 Daytime Sleep in the Hospital Yes 154 77 No 46 23 Person to Whom Sleep Problem Was Reported Nurse 157 78.5 Doctor 43 21.5 Taking Sleep Aids Yes - - No 200 100 Receiving Sleep Training in Hypertension Treatment Yes - - No 200 100 Daytime Sleep Yes 141 70.5 No 59 29.5 Table 3. RCSQ Sleep Quality Scores According to Patients' Sociodemographic Characteristics and Sleep-Related Features RCSQ Sleep Quality Score Mean ± SD Test p Gender Female 54.76±18.34 t=.278 0.781 Male 54,08±15,91 Marital Status Married 55,25±16,52 t=.641 0.649 Single 53,66±18,12 Comorbidity Yes 53.77±17.03 t=-1.218 0.230 No 58.00±18.13 Sleep Habit Regular 64.46±14.34 t=5.866 0.00* Irregular 50.56±16.73 Nighttime Sleep Duration Before Hospitalization 4-5 hours 46.24±15.04 F=61.281 0.00* 6-8 hours 63.72±13.85 9 hours or more 74.50±13.16 Daytime Sleep Yes 54.04±17.24 t=-0.522 0.63 No 55.44±17.33 Changes in Sleep Pattern After Hospitalization Yes 53.66±16.22 t=-.378 0.706 No 54.70±17.59 Ability to Sleep at Desired Time in the Hospital Yes 56.31±16.55 U=4.796 0.00* No 39.40±15.475 Waking Up During the Night in the Hospital Yes 52.01±15.91 U=-6.086 0.00* No 73.21±15.69 SD: Standard Deviation; F: One-Way ANOVA; t: Independent Sample t-test; U: Mann-Whitney U Test; *p < 0.05 Table 4. Assessment of Vital Signs According to Patients' Daytime Sleep Status Vital Signs Daytime Sleepers Today (n=85) Non-Daytime Sleepers Today (n=115) t / p Heart Rate Morning (08:00-12:00) 78.74±13.95 81.32±15.47 -1.127 / 261 Afternoon (16:00-20:00) 78.27±11.81 80.53±13.55 -1.091 / .277 t / p .467 / .641 -1.037 / .302 Systolic Blood Pressure Morning (08:00-12:00) 127.56±16.07 127.79±18.48 -.079 / .937 Afternoon (16:00-20:00) 122.15±15.33 128.76±17.21 -2.804 / .005* t / p 4.569 / .000* -2.183 / .031 Diastolic Blood Pressure Morning (08:00-12:00) 73.55±12.41 74.19±13.02 -.027 / .979 Afternoon (16:00-20:00) 71.58±10.25 76.16±13.21 -2.316 / .022* t / p 1.948 / .055 .918 / .361 Table 5. Multiple regression analysis of variables that affect the Sleep Quality score Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 22 Nov, 2025 Reviews received at journal 22 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 11 Oct, 2025 Reviewers agreed at journal 11 Oct, 2025 Reviews received at journal 10 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 09 Oct, 2025 Editor invited by journal 17 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 05 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7544584","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531854934,"identity":"efe6f9d4-6f90-4804-9d85-bf9616cd41e3","order_by":0,"name":"Vildan Kocatepe","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Vildan","middleName":"","lastName":"Kocatepe","suffix":""},{"id":531854935,"identity":"23919faf-c791-4d65-be92-8806e3f8d9b3","order_by":1,"name":"Havva Nur Poyraz","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Havva","middleName":"Nur","lastName":"Poyraz","suffix":""},{"id":531854936,"identity":"495c6ee3-46a0-4050-9c6e-2d9c33a78507","order_by":2,"name":"Selin Nemutlu","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Selin","middleName":"","lastName":"Nemutlu","suffix":""},{"id":531854937,"identity":"0710b6a0-af86-45fe-9fe3-3df6fb5e2a84","order_by":3,"name":"Banu Balım","email":"","orcid":"","institution":"Buca Seyfi Demirsoy Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Banu","middleName":"","lastName":"Balım","suffix":""},{"id":531854938,"identity":"d3f83424-5c79-4df0-a554-489b1f2386cc","order_by":4,"name":"Vesile Unver","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3RsWoCMRzH8X8InIvgGgfbV7hyIBZ9mISDc0nt0MXhKJnOxdL1oIOvcFvpFpDmlkDXjFeE63oglE5iLDq0xOvaId/pl+EDCQHw+f5psjqtBggFoIeJ2wk9DpT/IEGLORHc/d5/kLBcvEs6B/ZMYrWdpKNZbxG/FjAfM3H5UDmJ1qGkGthLnsRPXJE7ouvEgJ4yEXRCF+nnHCTLgBVaR/hGECYMHxqUrS1x36y/+qgk2x3I2xZfW7Iyt58G7c6THoFQMmFJucQYWVIYHhgkWkiX27coEhVlFqGlfcuVroeGqmmUBYmTBJ1y0zTpZFCs8Qa+0vvZRRnXpknHg0esnOQY+XWm0P6TPp/P52tvD/JjZiFEHwlAAAAAAElFTkSuQmCC","orcid":"","institution":"Acıbadem Mehmet Ali Aydınlar University","correspondingAuthor":true,"prefix":"","firstName":"Vesile","middleName":"","lastName":"Unver","suffix":""}],"badges":[],"createdAt":"2025-09-05 13:08:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7544584/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7544584/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07254-8","type":"published","date":"2026-03-19T15:58:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":94104577,"identity":"4081aa38-1c98-4f21-9124-c1af93b8a539","added_by":"auto","created_at":"2025-10-22 12:06:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":238458,"visible":true,"origin":"","legend":"","description":"","filename":"MANUSCRIPT.docx","url":"https://assets-eu.researchsquare.com/files/rs-7544584/v1/83b5f2b80f64c75ca3521fdf.docx"},{"id":94104578,"identity":"80ac5e95-63cc-4c7a-a2a2-9ad7a719edb5","added_by":"auto","created_at":"2025-10-22 12:06:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":151888,"visible":true,"origin":"","legend":"","description":"","filename":"TABLE.docx","url":"https://assets-eu.researchsquare.com/files/rs-7544584/v1/c00d03c903cd31a17e701125.docx"},{"id":94104576,"identity":"e173c31a-3cad-432e-b0d6-211924f4fdf5","added_by":"auto","created_at":"2025-10-22 12:06:08","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7202,"visible":true,"origin":"","legend":"","description":"","filename":"ae2a531243d143b0afcfec228faa162f.json","url":"https://assets-eu.researchsquare.com/files/rs-7544584/v1/8a266bcf802fff091f861ab1.json"},{"id":105223344,"identity":"8b7db80b-e6e9-4f2c-b240-567f270170f7","added_by":"auto","created_at":"2026-03-23 16:04:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1415415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7544584/v1/356fe184-a154-48ba-9a96-4068333632fb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Relationship Between Sleep Quality and Blood Pressure in Elderly Hypertensive Patients\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypertension (HT) affects 1.28 billion adults aged 30 to 79 worldwide, with two-thirds of these individuals living in low- and middle-income countries [1]. Although the definition of hypertension does not vary by age group, HT is more common in elderly individuals. The prevalence of HT is higher in people over the age of 65, making it a significant health concern for this age group [2]. The increase in life expectancy has significantly raised the percentage of individuals aged 65 and older in both developed and developing countries. Projections indicate that by 2050, 20% of the world\u0026rsquo;s population will be aged 65 and above [3].\u003c/p\u003e\n\u003cp\u003eShort sleep duration is a major risk factor for the development of hypertension. It has been found that older adults stay in bed longer but sleep less compared to younger individuals [4, 5]. Hypertension is associated with poor sleep quality and decreased sleep efficiency [6]. Another factor that increases the risk of hypertension is the increase in daytime sleep due to reduced nighttime sleep duration, which is observed in a significant portion of elderly patients [7]. A study conducted in the United States found that 44.7% of individuals with hypertension had sleep disorders, 31.7% had short sleep duration, and 30.3% had poor sleep quality [8]. Similarly, a study conducted in Brazil reported poor sleep quality among hypertensive individuals [9]. One of the reasons for the poor prognosis of hypertension is low sleep quality [10]. A study in China also reported that individuals with good sleep quality had significantly lower systolic and diastolic blood pressure levels compared to those with poor sleep quality. Additionally, the prevalence of hypertension was significantly higher among individuals with poor sleep quality, which was found to increase both systolic and diastolic blood pressure .[11]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSleep is an important parameter for enhancing quality of life and maintaining overall well-being [12]. It is a fundamental physiological necessity, essential for human survival [13]. A study reported that different stages of sleep could lead to increases in blood pressure [14]. It has been found that older adults stay in bed longer but sleep less compared to younger individuals [4, 5]. A study conducted in Turkey revealed that hypertensive patients with good sleep quality had significantly higher blood pressure control rates than those with poor sleep quality [6]. These findings suggest that elevated blood pressure may contribute to various symptoms that impair sleep quality, or conversely, poor sleep quality may lead to increased blood pressure. Furthermore, while daytime sleep has known benefits, frequent daytime napping\u0026mdash;especially among older adults\u0026mdash;has been reported to be associated with hypertension [15, 16].\u003c/p\u003e\n\u003cp\u003eNurses play a critical role in identifying, interpreting, and managing insomnia in patients. Both subjective data from the patient and objective assessment methods can be used to evaluate sleep duration and quality. Many patients do not inform healthcare professionals about their sleep issues; therefore, it is essential to regularly ask all patients about their sleep patterns. A sleep history should include factors such as the duration of sleep, sleep routine, and daytime alertness [17]. Nurses must also take a multifaceted approach to hypertension management. They should guide patients in areas such as diagnosis, medication monitoring, patient education, counseling, and skill development. In particular, patient education is crucial in improving treatment adherence and positively influencing the course of the disease [18]. For nurses, it is important to first identify these issues and determine the relationship between sleep quality and hypertension in elderly individuals, as they play a significant role in managing insomnia and maintaining blood pressure control. A literature review found limited studies examining the relationship between sleep and hypertension [6, 8, 9, 11]. Among studies focusing on older adults, only research investigating the effects of daytime sleep on hypertension was found [15]. Therefore, this study was conducted to examine the relationship between sleep quality and blood pressure in elderly hypertensive patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted using a descriptive, correlational, and cross-sectional design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe population of the study consisted of all patients hospitalized in the internal medicine clinic of a training and research hospital between October 2023 and June 2024 who met the inclusion criteria. The sample included patients who: were aged 65 years and older, had a diagnosis of hypertension; patients were excluded from the study if they: had a neurological diagnosis affecting cognitive function (e.g., dementia, Alzheimer\u0026apos;s), had a psychiatric disorder affecting sleep quality (e.g., insomnia), lacked orientation to time, place, or person, had hearing or speech impairments,were using sleep medication. The sample size was calcu-lated using the G*Power 3.1.9.7 programme based on the formula of the sample with infinite population. The sample size was foundto be at least 169 patients at the effect size of 0.3, an error margin of 0.05 and a power level of 95%. Considering the possibility ofwithdrawal from the study and missing data, a total of 200 patientswere included in the sample. When the required sample size forthe study was reached, the data collection process was completed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a face-to-face method. The Patient Diagnosis Form and the Richard Campbell Sleep Quality Scale were used to obtain the data. It took approximately 15-20 minutes for the patients to complete the data collection forms. The patients\u0026apos; vital signs were measured and recorded by the researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive Characteristics Form\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe form was developed by the researchers based on the literat\u0026uuml;re [6, 8, 9, 11, 14]. The form consists of a total of 30 questions divided into the following sections:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePersonal Characteristics:\u003c/em\u003e Includes five questions regarding gender, age, marital status, education level, and employment status.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisease-Related Characteristics:\u003c/em\u003e Includes five questions regarding chronic disease status and medications.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSleep Habits Characteristics:\u003c/em\u003e Includes 16 questions exploring sleep habits, sleep problems, daytime sleep duration, sleep patterns in the hospital, and sleep education.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBlood Pressure-Related Characteristics:\u003c/em\u003e Includes four questions related to blood pressure.\u003c/p\u003e\n\u003cp\u003eTo assess the effect of daytime sleep on blood pressure, blood pressure readings were taken from the patients at two different times: in the morning and in the afternoon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRichards Campbell Sleep Quality Scale (RCSQ)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Richards Campbell Sleep Quality Scale (RCSQ) was developed by Richards in 1987 as a diagnostic tool to assess sleep quality in patients receiving care in critical care settings [19]. The scale evaluates various aspects of a patient\u0026apos;s nighttime sleep, including the depth of sleep, time taken to fall asleep, frequency of awakenings, duration of wakefulness after waking up, overall sleep quality, and the level of noise in the environment. Each item is assessed by the patient using a 0-100 visual analog scale to query their nighttime sleep experience. In the validity and reliability study conducted by Richards, the Cronbach\u0026apos;s \u0026alpha; value of the scale was reported to be 0.82 [19]. The Turkish validity and reliability of the scale were performed by Karaman \u0026Ouml;zl\u0026uuml; and \u0026Ouml;zer in 2015, with the Cronbach\u0026apos;s \u0026alpha; value reported as 0.91 [20].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll collected data were transferred to the SPSS software for analysis. For the analysis of data related to personal characteristics, disease-related characteristics, sleep habits, and blood pressure characteristics, frequency, percentage, mean, median, and standard deviation were used. Based on the results of the normality test, for normally distributed measurements, the independent t-test was used to compare two groups, one-way ANOVA was used for comparing multiple groups, and Pearson correlation analysis was conducted for relational inferences. For non-normally distributed measurements, the Mann-Whitney U test was used for comparing two groups, the Kruskal-Wallis test was used for comparing multiple groups, and Spearman correlation analysis was used for relational inferences. A statistical significance level of 0.05 was used for all analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the XXX Demokrasi University Non-Interventional Research Ethics Committee (decision number 2023/67- 14.06.2023). Informed consent was obtained from all individual participants included in the study. The research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThe average age of the patients participating in the study was 76.36 \u0026plusmn; 7.70 years, and the average duration of hypertension was 15.63 \u0026plusmn; 9.61 years. 54.5% of the participants were women. 55% of the patients were married. Regarding education, 15% of the participants were illiterate, 69.5% had primary education, 14% had secondary education, and 1.5% had a bachelor\u0026apos;s degree or higher. 98% of the patients were not employed. The presence of comorbidities in the participants was 84%, with the following conditions observed: Diabetes Mellitus in 60.5%, Coronary Heart Disease-Heart Failure in 38%, Chronic Obstructive Pulmonary Disease in 12.5%, Chronic Kidney Failure in 12.5%, and Cancer in 8%. 98% of the patients reported that their medication dose had not been increased in the past year, and 92% indicated that their medication had not been changed in the past year (Table 1).\u003c/p\u003e\n\u003cp\u003eThe average daytime sleep duration of the patients was 61.63 \u0026plusmn; 32.31 hours. 28% of the elderly patients reported having a regular sleep habit. Before being admitted to the hospital, 55.5% of the participants reported sleeping 4-5 hours, 40.5% reported 6-8 hours, and 4% reported 9 hours or more. 70.5% of the patients stated that they napped before being hospitalized, while 57.5% answered \u0026quot;no\u0026quot; regarding napping today. Regarding changes in sleep patterns after hospitalization, 76% of the patients responded \u0026quot;no\u0026quot; to experiencing changes. Among those who reported negative changes, 6% indicated \u0026quot;I had difficulty falling asleep,\u0026quot; 7% indicated \u0026quot;I started waking up frequently,\u0026quot; 0.5% indicated \u0026quot;I started waking up very early,\u0026quot; 3.5% indicated \u0026quot;My nighttime sleep duration decreased,\u0026quot; 1% indicated \u0026quot;I started having insomnia complaints at night,\u0026quot; 1% indicated \u0026quot;I started feeling like I hadn\u0026apos;t slept at all when I woke up in the morning,\u0026quot; and 2% indicated \u0026quot;My bedtime changed.\u0026quot; Regarding positive changes after hospitalization, 10% of patients reported \u0026quot;I started falling asleep more easily,\u0026quot; 1% reported \u0026quot;I started feeling more rested in the morning,\u0026quot; and 1% reported \u0026quot;My bedtime became regular.\u0026quot; 89% of the patients stated that they could sleep at their desired time in the hospital. 88.5% of the patients answered \u0026quot;yes\u0026quot; to waking up during the night, with 5.5% waking up once, 27% waking up twice, and 58.5% waking up three or more times. 77% of the patients reported napping during the day in the hospital. 78.5% of the patients indicated that the person they communicated their sleep problem to was the nurse. 100% of the patients did not take sleep aids, and 100% did not receive sleep education as part of their hypertension treatment. 70.5% of the patients answered \u0026quot;yes\u0026quot; to napping during the day (Table 2).\u003c/p\u003e\n\u003cp\u003eThe average score of the patients on the Richards Campbell Sleep Quality Scale (RCSQ) was found to be 54.45 \u0026plusmn; 17.23. There was no statistically significant difference in RCSQ sleep quality scores according to gender, marital status, comorbidity, daytime napping, and changes in sleep patterns after hospitalization. However, statistically significant differences were found in RCSQ sleep quality scores according to the patients\u0026apos; sleep habits (t=5.866; p\u0026lt;0.01), sleep duration before hospitalization (F=61.281; p=0.00), ability to sleep at their desired time in the hospital (U=4.796; p=0.00), and night waking occurrences (U=-6.086; p=0.00) (Table 3).\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was found in the afternoon (16:00) systolic blood pressures of patients according to their daytime napping status (t=-2.804 / p=0.005). A statistically significant difference was also found in the afternoon diastolic blood pressures of patients based on their daytime napping status (t=-2.316 / p=0.022). Among patients who napped during the day, a statistically significant difference was found between their morning and afternoon systolic blood pressures (t=4.569; p˂0.001) (Table 4).\u003c/p\u003e\n\u003cp\u003eNo statistically significant correlation found between the patients\u0026apos; daytime sleep duration and their vital signs. A moderate, negative statistically significant relationship was found between the RCSQ sleep quality scores and the morning heart rate (r= -0.49; p=-0.171). Apart from the morning heart rate, no statistically significant correlation was found between the sleep quality scores and other vital signs.\u003c/p\u003e\n\u003cp\u003eConsidering the analysis results, the model established was statistically significant (F = 16.078, p\u0026lt;0.001). The model including gender, ability to sleep at desired time in the hospital, sleep habit and nighttime sleep duration before hospitalization variables were found to be statistically significant, explaining 24.8% of the variance in the RCSQ Total Score (p\u0026lt;0.05). According to the standardised regression coefficient (\u0026beta;), ability to sleep at desired time in the hospital (yes) (\u0026beta;=0.299), Sleep Habit (regular) (\u0026beta;=0.318) and nighttime sleep duration before hospitalization (9 hours and over) (\u0026beta;=0.167) were found to affect the RCSQ Total Score. Ability to sleep at desired time in the hospital (yes) increases \u0026nbsp;the sleep quality score by 0.299 times, sleep habit (regular) 0.318 times and nighttime sleep duration before hospitalization (9 hours and over) 0.167 times. Table 5 presents the results.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study emphasizes the importance of daytime naps and sleep quality in elderly hypertensive patients and highlights the need for nurses to play a more active role in improving sleep quality. One of the most important findings in this study is that the average daytime sleep duration of the patients was 61.63 \u0026plusmn; 32.31 minutes. This duration is quite long and is consistent with the literature suggesting that long daytime sleep can increase the risk of hypertension in older individuals [15, 16]. Only 28% of the patients reported having a regular sleep habit. Irregular sleep patterns may complicate the control of hypertension [8, 9] . Furthermore, in terms of sleep duration, 55.5% of the patients slept for 4-5 hours, 40.5% for 6-8 hours, and 4% for 9 hours or more. According to the literature, sleeping less than 6 hours is a significant risk factor for hypertension [11]. These findings support the literature on the importance of sleep duration and quality in the management of hypertension.\u003c/p\u003e\n\u003cp\u003eThe factors negatively affecting the patients\u0026apos; sleep quality include their existing irregular sleep habits and the fact that their sleep duration before hospitalization was 4-5 hours. On the other hand, the ability to sleep at their desired time in the hospital has a positive impact on their sleep quality. Furthermore, although most of our patients experienced an increase in nighttime awakenings after hospitalization, 76% of them reported that there was no change in their sleep pattern in the hospital. This suggests that patients may not be aware of the impact that nighttime sleep fragmentation could have on their hypertension. The frequent nighttime awakenings of patients is a significant factor that greatly reduces sleep quality. The finding of a meaningful difference between nighttime awakenings and sleep quality in this study underscores the importance of sleep fragmentation in the management of hypertension. The literature suggests that frequent nighttime awakenings are common in patients with hypertension and negatively impact blood pressure regulation [14].\u003c/p\u003e\n\u003cp\u003eThe literature clearly highlights the impact of sleep problems on the prevalence of hypertension. In a study examining the effects of sleep quality on hypertension, it was found that shorter sleep duration and self-reported sleep problems were each associated with an increased risk of hypertension. Additionally, a positive relationship was identified between poor sleep patterns and the risk of hypertension [21].\u0026nbsp;A study examining the relationship between sleep duration, sleep quality, and hypertension prevalence in individuals aged 65 and older found that as sleep quality decreased, the risk of hypertension increased. Additionally, the study indicated a \u0026quot;U\u0026quot; shaped relationship between sleep duration and hypertension risk, suggesting that both short and long sleep durations are associated with an increased risk of hypertension [22].\u003c/p\u003e\n\u003cp\u003eThe majority of patients reported having a sleep duration of 4-5 hours before hospitalization, with daytime sleep durations exceeding 60 minutes on average. However, most patients stated that there was no change in their sleep patterns after being admitted to the hospital. Despite this, our results indicate an increase in both nighttime awakenings and daytime sleep frequency following hospitalization. In terms of the impact of daytime sleep on vital signs, the results show that patients who napped during the day had lower systolic and diastolic blood pressures compared to those who did not nap. To date, there have been no studies examining the relationship between daytime sleep and vital signs in hospitalized patients. However, most community-based studies exploring the relationship between daytime sleep and hypertension have primarily focused on the Chinese population [23\u0026ndash;25]. The relationship between daytime sleep and hypertension is still not fully understood. One study has suggested that daytime sleep may provide cardiovascular benefits by reducing psychological stress [26]. The results of a study conducted by Huang and colleagues showed that daytime sleep lasting more than 60 minutes significantly reduced the prevalence of hypertension. Additionally, this protective effect was found to be effective in individuals who also had an appropriate nighttime sleep duration of 7-8 hours [27].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCai and colleagues demonstrated that napping (siesta) is associated with a reduction in the prevalence of hypertension among older adults in China [25]. Zhao and colleagues have stated that populations with a daytime sleep habit have a lower prevalence of hypertension compared to those who do not nap at all [24]. In the present study, it was observed that patients who took daytime naps had lower both systolic and diastolic blood pressure. Additionally, the literature suggests that prolonged daytime naps, particularly in women (\u0026gt;60 minutes), are associated with a reduced prevalence of hypertension [28]. The most recent study reflecting the Chinese population suggests that long daytime naps (\u0026gt;30 minutes) could be an independent risk factor for the first ischemic stroke in hypertensive individuals. It also indicates that the optimal duration of daytime naps for hypertensive individuals should be 30 minutes or less, highlighting the potential risks associated with prolonged naps in this group [23]. This study is the first to explore the impact of daytime naps on vital signs in hypertensive patients in our country. The observed decrease in both diastolic and systolic blood pressure with an average one-hour daytime nap in patients can be attributed to a physiological effect related to the rest and relaxation experienced during the nap.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasises the importance of daytime sleep and patient sleep quality on vital signs in elderly hypertensive patients and shows that nurses should take a more active role to improve sleep quality. The study found that 77% of patients took daytime naps, with an average nap duration of approximately one hour. The results regarding the effect of daytime naps on vital signs show that patients who took naps had lower systolic and diastolic blood pressure compared to those who did not. The decrease in both diastolic and systolic blood pressure with an average one-hour nap in patients can be attributed to a physiological effect related to rest. The findings once again confirm that sleep quality is a crucial parameter in hypertension management. Regulating sleep habits, reducing nighttime awakenings, and optimizing sleep duration can improve sleep quality. Based on these results, nurses should individually assess sleep patterns and duration in patients and provide education on sleep hygiene. Moreover, the duration of daytime naps should be monitored. Nurses should inquire about sleep patterns in hypertension management and provide necessary guidance.\u003c/p\u003e\n"},{"header":"LIMITATIONS","content":"\u003cp\u003eThis study is single-center, so its findings may not be generalizable to all elderly hypertensive patients. The data on sleep duration and sleep quality were based on patient self-reports, which can introduce a risk of bias. Since objective assessment methods (such as polysomnography or actigraphy) were not used, the measurements may have been subjective. Future studies can be designed with these objective methods for more accurate data collection. Additionally, psychosocial factors (stress, depression, anxiety) and other factors that may affect hypertension and sleep quality, such as patients\u0026apos; nutritional habits and physical activity levels, could not be standardized, and may have influenced sleep quality. These limitations should be considered when interpreting the study results.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Izmir Demokrasi University Non-Interventional Research Ethics Committee (decision number 2023/67- 14.06.2023). Informed consent was obtained from all individual participants included in the study. The research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration Number:\u003c/strong\u003e This study is not a clinical trial; therefore, registration was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have confrmed that they have no conficts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported and funded by The Scientific and Technological Research Council of Turkey (TUBITAK, Project No: 1919B012302178).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO). Hypertension. 2023.\u003c/li\u003e\n\u003cli\u003eKolcu M, Erg\u0026uuml;n A. The Role of Nurses in Hypertension Management Among Elderly. Journal of Health Sciences and Professions. 2016;3:234\u0026ndash;41. https://doi.org/10.17681/HSP.23573.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zerkan \u0026Ccedil;akan F. Hypertension in the elderly. Archive of Turkish Cardiological Association. 2017;45 Supp:5:29\u0026ndash;31. https://doi.org/10.5543/TKDA.2017.95554.\u003c/li\u003e\n\u003cli\u003eMartin D, Hurlbert A, Cousins DA. Sleep Disturbance and the Change from White to Red Lighting at Night on Old Age Psychiatry Wards: A Quality Improvement Project. Arch Psychiatr Nurs. 2018;32:379\u0026ndash;83. https://doi.org/10.1016/J.APNU.2017.12.001.\u003c/li\u003e\n\u003cli\u003eTroynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018;78:192\u0026ndash;203. https://doi.org/10.1016/J.JTHERBIO.2018.09.012.\u003c/li\u003e\n\u003cli\u003eYılmaz Y, Hacıhasanoğlu Aşılar R. Effect of Sleep Quality on Self Care Agency and Blood Pressure Control in Hypertensive Patients. Journal of Turkish Sleep Medicine. 2022;9:278\u0026ndash;87. https://doi.org/10.4274/JTSM.GALENOS.2022.19970.\u003c/li\u003e\n\u003cli\u003eUchmanowicz I, Markiewicz K, Uchmanowicz B, Kołtuniuk A, Rosińczuk J. The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clin Interv Aging. 2019;14:155\u0026ndash;65. https://doi.org/10.2147/CIA.S188499.\u003c/li\u003e\n\u003cli\u003eBansil P, Kuklina E V., Merritt RK, Yoon PW. Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008. J Clin Hypertens (Greenwich). 2011;13:739\u0026ndash;43. https://doi.org/10.1111/J.1751-7176.2011.00500.X.\u003c/li\u003e\n\u003cli\u003eHanus JS, Amboni G, da Rosa MI, Ceretta LB, Tuon L. The quality and characteristics of sleep of hypertensive patients. Rev Esc Enferm USP. 2015;49:594\u0026ndash;9. https://doi.org/10.1590/S0080-623420150000400009.\u003c/li\u003e\n\u003cli\u003eAlebiosu OC, Ogunsemi OO, Familoni OB, Adebayo PB, Ayodele OE. Quality of sleep among hypertensive patients in a semi-urban Nigerian community: a prospective study. Postgrad Med. 2009;121:166\u0026ndash;72. https://doi.org/10.3810/PGM.2009.01.1969.\u003c/li\u003e\n\u003cli\u003eLiu RQ, Qian Z, Trevathan E, Chang JJ, Zelicoff A, Hao YT, et al. Poor sleep quality associated with high risk of hypertension and elevated blood pressure in China: results from a large population-based study. Hypertens Res. 2016;39:54\u0026ndash;9. https://doi.org/10.1038/HR.2015.98.\u003c/li\u003e\n\u003cli\u003eBai C, Guo M, Yao Y, Ji JS, Gu D, Zeng Y. Sleep duration, vegetable consumption and all-cause mortality among older adults in China: a 6-year prospective study. BMC Geriatr. 2021;21:1\u0026ndash;12. https://doi.org/10.1186/S12877-021-02278-8/TABLES/3.\u003c/li\u003e\n\u003cli\u003eOng AD, Kim S, Young S, Steptoe A. Positive affect and sleep: A systematic review. Sleep Med Rev. 2017;35:21\u0026ndash;32. https://doi.org/10.1016/J.SMRV.2016.07.006.\u003c/li\u003e\n\u003cli\u003eShantsila A, Shantsila E, Lip GYH. Hypertension and sleep health: a multidimensional puzzle. J Hypertens. 2021;39:600\u0026ndash;1. https://doi.org/10.1097/HJH.0000000000002743.\u003c/li\u003e\n\u003cli\u003eCao Z, Shen L, Wu J, Yang H, Fang W, Chen W, et al. The effects of midday nap duration on the risk of hypertension in a middle-aged and older Chinese population: a preliminary evidence from the Tongji-Dongfeng Cohort Study, China. J Hypertens. 2014;32:1993\u0026ndash;8; discussion 1998. https://doi.org/10.1097/HJH.0000000000000291.\u003c/li\u003e\n\u003cli\u003eMantua J, Spencer RMC. Exploring the nap paradox: are mid-day sleep bouts a friend or foe? Sleep Med. 2017;37:88\u0026ndash;97. https://doi.org/10.1016/J.SLEEP.2017.01.019.\u003c/li\u003e\n\u003cli\u003eKocatepe V, Yıldırım D. Sleeplessness. In: Oğuz S., \u0026Uuml;nver V., \u0026Ccedil;amcı G., Kocatepe V, editors. Semptom Y\u0026ouml;netimi ve Hemşirelik. 2022.\u003c/li\u003e\n\u003cli\u003eYıldırım N, Durna Z. The Role of the Nurse in Hypertension Management. J Midwifery and Health Sci. 2021;4:305\u0026ndash;15. https://doi.org/10.1097/HJH.0000000000002453.\u003c/li\u003e\n\u003cli\u003eRichards K. Techniques for measurement of sleep in critical care. Focus Crit Care. 1987;14:34\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eKaraman \u0026Ouml;zl\u0026uuml; Z, \u0026Ouml;zer N. Richard-Campbell Sleep Questionnaire Validity and Reliability Study. Journal of Turkish Sleep Medicine. 2015;2:29\u0026ndash;32. https://doi.org/10.4274/JTSM.02.008.\u003c/li\u003e\n\u003cli\u003eLi C, Shang S. Relationship between Sleep and Hypertension: Findings from the NHANES (2007-2014). Int J Environ Res Public Health. 2021;18. https://doi.org/10.3390/IJERPH18157867.\u003c/li\u003e\n\u003cli\u003eMengling T, Fang W, Huafang Z, Huifen D, Xinqiang Z, Zhebin Y, et al. [Association between sleep and prevalence of hypertension in elderly population]. Zhonghua Liu Xing Bing Xue Za Zhi. 2021;42:1188\u0026ndash;93. https://doi.org/10.3760/CMA.J.CN112338-20200512-00713.\u003c/li\u003e\n\u003cli\u003eWu J, Liu L, Huang Z, Wang L, Cai F, Li A, et al. Long daytime napping: A silent danger for hypertensive individuals. Eur J Neurol. 2024;31. https://doi.org/10.1111/ENE.16382.\u003c/li\u003e\n\u003cli\u003eZhao H, Gui W, Huang H, Liu Y, Ding H, Fan W, et al. Association of long-term sleep habits and hypertension: a cross-sectional study in Chinese adults. J Hum Hypertens. 2020;34:378\u0026ndash;87. https://doi.org/10.1038/S41371-019-0225-8.\u003c/li\u003e\n\u003cli\u003eCai M, Huang Y, Sun X, He Y, Sun C. Siesta is associated with reduced systolic blood pressure level and decreased prevalence of hypertension in older adults. J Hum Hypertens. 2016;30:216\u0026ndash;8. https://doi.org/10.1038/JHH.2015.70.\u003c/li\u003e\n\u003cli\u003eBrindle RC, Conklin SM. Daytime sleep accelerates cardiovascular recovery after psychological stress. Int J Behav Med. 2012;19:111\u0026ndash;4. https://doi.org/10.1007/S12529-011-9150-0.\u003c/li\u003e\n\u003cli\u003eHuang M, Yang Y, Huang Z, Yuan H, Lu Y. The association of nighttime sleep duration and daytime napping duration with hypertension in Chinese rural areas: a population-based study. J Hum Hypertens. 2021;35:896\u0026ndash;902. https://doi.org/10.1038/S41371-020-00419-X.\u003c/li\u003e\n\u003cli\u003eYang Y, Liu W, Ji X, Ma C, Wang X, Li K, et al. Extended afternoon naps are associated with hypertension in women but not in men. Heart Lung. 2020;49:2\u0026ndash;9. https://doi.org/10.1016/J.HRTLNG.2019.09.002.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Personal and Disease-Related Characteristics (n=200)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 66.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 66.6667%;\"\u003e\n \u003cp\u003e76.36\u0026plusmn; 7.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 66.6667%;\"\u003e\n \u003cp\u003e15.63\u0026plusmn; 9.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;Illiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePrimary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e69.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eSecondary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid Disease (n=168)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e60.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eCoronary Heart Disease-Heart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eChronic Kidney Failure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncrease in medication dosage in the last year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in medication in the last year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Characteristics of Patients Related to Sleep (n=200)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 454px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep Duration (minute)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e61.63\u0026plusmn; 32.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Habit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNighttime Sleep Duration Before Hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e4-5 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e55.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e6-8 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e9 hours or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep Before Hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep Status Today\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in Sleep Pattern After Hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChanges in Sleep Pattern After Hospitalization (Negative)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI had difficulty falling asleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI started waking up frequently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI began waking up very early in the morning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMy nighttime sleep duration decreased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI began feeling like I hadn\u0026rsquo;t slept at all when I woke up in the morning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eStarted insomnia at night\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMy bedtime changed at night\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChanges in Sleep Pattern After Hospitalization (Positive)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI started sleeping more comfortably\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eI began feeling more rested when I woke up\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMy bedtime became more regular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbility to Sleep at Desired Time in the Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaking Up During the Night in the Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e88.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIf yes; how many times?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOnce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eThree or more times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep in the Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerson to Whom Sleep Problem Was Reported\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e78.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTaking Sleep Aids\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceiving Sleep Training in Hypertension Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. RCSQ Sleep Quality Scores According to Patients\u0026apos; Sociodemographic Characteristics and Sleep-Related Features\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 369px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRCSQ Sleep Quality Score Mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54.76\u0026plusmn;18.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54,08\u0026plusmn;15,91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e55,25\u0026plusmn;16,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e53,66\u0026plusmn;18,12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e53.77\u0026plusmn;17.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=-1.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e58.00\u0026plusmn;18.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Habit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e64.46\u0026plusmn;14.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=5.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50.56\u0026plusmn;16.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNighttime Sleep Duration Before Hospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e4-5 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e46.24\u0026plusmn;15.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eF=61.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e6-8 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e63.72\u0026plusmn;13.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e9 hours or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e74.50\u0026plusmn;13.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54.04\u0026plusmn;17.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=-0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e55.44\u0026plusmn;17.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChanges in Sleep Pattern After Hospitalization\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e53.66\u0026plusmn;16.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=-.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54.70\u0026plusmn;17.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbility to Sleep at Desired Time in the Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e56.31\u0026plusmn;16.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eU=4.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e39.40\u0026plusmn;15.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaking Up During the Night in the Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52.01\u0026plusmn;15.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eU=-6.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e73.21\u0026plusmn;15.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;SD: Standard Deviation; F: One-Way ANOVA; t: Independent Sample t-test; U: Mann-Whitney U Test; *p \u0026lt; 0.05\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Assessment of Vital Signs According to Patients\u0026apos; Daytime Sleep Status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"946\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVital Signs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDaytime Sleepers Today (n=85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Daytime Sleepers Today (n=115)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et / p\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMorning (08:00-12:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e78.74\u0026plusmn;13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e81.32\u0026plusmn;15.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e-1.127 / 261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAfternoon (16:00-20:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e78.27\u0026plusmn;11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e80.53\u0026plusmn;13.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e-1.091 / .277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003et / p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e.467 / .641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e-1.037 / .302\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystolic Blood Pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMorning (08:00-12:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e127.56\u0026plusmn;16.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e127.79\u0026plusmn;18.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e-.079 / .937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAfternoon (16:00-20:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e122.15\u0026plusmn;15.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e128.76\u0026plusmn;17.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-2.804 / .005*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003et / p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e4.569 / \u003cstrong\u003e.000*\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e-2.183 / .031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiastolic Blood Pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMorning (08:00-12:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e73.55\u0026plusmn;12.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e74.19\u0026plusmn;13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e-.027 / .979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAfternoon (16:00-20:00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e71.58\u0026plusmn;10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e76.16\u0026plusmn;13.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-2.316 / .022* \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003et / p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1.948 / .055\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e.918 / .361\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 5. Multiple regression analysis of variables that affect the Sleep Quality score\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg 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more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Elderly, Hypertension, Sleep Quality, Vital Signs, Daytime Sleepiness","lastPublishedDoi":"10.21203/rs.3.rs-7544584/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7544584/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTherefore, this study was conducted to examine the relationship between sleep quality and blood pressure in elderly hypertensive patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study was conducted using a descriptive, correlational, and cross-sectional design. The sample consisted of 200 patients over the age of 65 who were diagnosed with hypertension and hospitalized in the internal medicine clinic of a training and research hospital between October 2023 and June 2024. The Patient Identification Form and the Richard Campbell Sleep Quality Scale were used to obtain the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean age of the elderly patients participating in the study was 76.36 ± 7.70 years, and the average duration of hypertension was 15.63 ± 9.61 years. The mean daytime sleep duration of the patients was found to be 61.63 ± 32.31 minutes. A total of 28% of the elderly patients reported having a regular sleep habit. The mean score of the Richards Campbell Sleep Quality Scale (RCSQ) was 54.45 ± 17.23. There was a statistically significant difference in RCSQ sleep quality scores based on sleep habits (t=5.866; p\u0026lt;0.01), sleep duration before hospitalization (F=61.281; p=0.00), ability to sleep at the desired time in the hospital (U=4.796; p=0.00), and nighttime awakenings (U=-6.086; p=0.00). Ability to sleep at desired time in the hospital (yes) increases the sleep quality score by 0.299 times, sleep habit (regular) 0.318 times and nighttime sleep duration before hospitalization (9 hours and over) 0.167 times.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings regarding the effects of daytime sleep on vital signs indicate that elderly patients who take daytime naps have lower systolic and diastolic blood pressure compared to those who do not.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Sleep Quality and Blood Pressure in Elderly Hypertensive Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 12:06:04","doi":"10.21203/rs.3.rs-7544584/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-22T18:50:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T11:27:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244215081457755972530726128868444795484","date":"2025-11-14T10:07:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T07:49:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50642710520187584300827572978841224396","date":"2025-10-11T12:51:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143596074400527726995771245671044333336","date":"2025-10-11T12:48:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T06:24:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89952621441286482776929341736543174076","date":"2025-10-10T06:02:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30547587882762174215429855880074863703","date":"2025-10-09T18:21:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T12:04:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-17T08:00:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T06:07:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T06:05:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-09-05T13:04:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"910af836-fa9d-41bf-8fd6-91acf8a8d552","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:01:19+00:00","versionOfRecord":{"articleIdentity":"rs-7544584","link":"https://doi.org/10.1186/s12877-026-07254-8","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-03-19 15:58:35","publishedOnDateReadable":"March 19th, 2026"},"versionCreatedAt":"2025-10-22 12:06:04","video":"","vorDoi":"10.1186/s12877-026-07254-8","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07254-8","workflowStages":[]},"version":"v1","identity":"rs-7544584","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7544584","identity":"rs-7544584","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}