Abstract
OBJECTIVE: Obstructive sleep apnea (OSA) is a recognized risk factor for hypertension, contributing to cardiovascular disease through mechanisms like nocturnal hypoxia and sympathetic dysfunction. The role of bedtime habits in OSA-associated hypertension remains underexplored. This study investigates the association between bedtime habits and hypertension in OSA patients. METHODS: A cross-sectional study analyzed baseline data from 6,193 community-dwelling adults in Guangdong Province, China, were analyzed. Sleep behavior habits and quality were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Self-reported bedtime was categorized as early (≤ 21:59), moderate (22:00–23:59), or late (≥ 00:00). OSA was diagnosed using a Type IV wearable intelligent sleep monitor. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or self-reported hypertension history. RESULT: OSA was present in 2,660 participants (42.9%). Among individuals with OSA, hypertension prevalence was 56.6% in early bedtimes, 36.9% in moderate bedtimes, and 30.7% in late bedtimes (P < 0.001). In the fully adjusted model, moderate bedtime (OR 0.64, 95% CI 0.48–0.86) and late bedtime (OR 0.67, 95% CI 0.47–0.95) were associated with lower odds of prevalent hypertension compared with early bedtime (reference). Early bedtime remained associated with longer sleep latency, lower sleep efficiency, and higher Pittsburgh Sleep Quality Index and Insomnia Severity Index scores (all P < 0.05). CONCLUSION: Early bedtime (≤ 21:59) was independently associated with higher odds of comorbid hypertension in adults with OSA, while moderate and late bedtimes were associated with lower odds after comprehensive adjustment. Bedtime represents a volitional lifestyle behavior that may be targeted for cardiovascular risk reduction in OSA. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11325-026-03579-1.