Feeling excessively sleepy during the day is more than a nuisance — it may be an independent warning sign for high blood pressure. A new study from Penn State College of Medicine finds that excessive daytime sleepiness is associated with 52% higher odds of having hypertension and 74% higher odds of developing it over the following years. When combined with difficulty falling asleep at night, the risk escalates sharply.
The research, to be presented June 17 at SLEEP 2026 in Baltimore and published in an online supplement of the journal Sleep, draws from the Penn State Adult Cohort — a well-characterized population sample that has been studied for decades.
The Numbers
The study analyzed 1,741 adults at baseline, with a subset of 786 participants without hypertension followed for an average of 7.5 years to track new diagnoses.
Individuals reporting excessive daytime sleepiness had significantly elevated cardiovascular risk:
- 52% higher odds of already having hypertension (prevalent hypertension)
- 74% higher odds of developing hypertension during follow-up (incident hypertension)
But the most striking finding emerged when researchers looked at a specific subgroup: people who reported excessive daytime sleepiness and took 30 minutes or more to fall asleep, as objectively measured by polysomnography (an overnight sleep study).
In this combined-risk group, the odds of prevalent hypertension more than doubled, and the odds of developing new hypertension more than tripled compared to normal controls.
A Distinct Cardiovascular Risk Group
"Adults with excessive daytime sleepiness and prolonged sleep-onset latency appeared to represent a distinct subgroup with significantly greater cardiovascular risk," said lead author Dr. Alexandros Vgontzas, a professor of psychiatry and director of the Sleep Research and Treatment Center at Penn State College of Medicine.
The distinction matters because these two symptoms point in different directions. Excessive daytime sleepiness typically signals insufficient or fragmented sleep — the kind seen in obstructive sleep apnea, shift work, or chronic sleep restriction. Prolonged sleep-onset latency, on the other hand, is a hallmark of hyperarousal — a state of elevated physiological activation that prevents the body from transitioning into sleep despite being tired.
When both conditions coexist, the patient experiences a particularly damaging cycle: hyperarousal keeps the cardiovascular system in an activated state around the clock, while the resulting poor sleep quality fails to provide the nocturnal blood pressure dip that protects against vascular damage.
Why Daytime Symptoms Matter
Most research on sleep and cardiovascular health focuses on nighttime metrics — sleep duration, apnea severity, oxygen levels. This study shifts attention to a daytime symptom that clinicians can assess with a simple question: "Do you feel excessively sleepy during the day?"
The study used polysomnography to objectively measure sleep-onset latency, making the results more robust than studies relying solely on self-report. The 30-minute threshold for prolonged sleep onset aligns with clinical definitions of sleep-onset insomnia and provides a clear, measurable cutoff that could be incorporated into cardiovascular risk assessment.
Limitations
The Penn State Adult Cohort is a predominantly white sample from central Pennsylvania, which may limit generalizability to more diverse populations. The study measured excessive daytime sleepiness by self-report rather than with objective tools like the Multiple Sleep Latency Test. And while the 7.5-year follow-up for incident hypertension is substantial, the observational design cannot establish that sleepiness directly causes hypertension — shared risk factors like obesity, sleep apnea, and chronic stress could contribute to both.
What This Means for Patients
For people who feel excessively sleepy during the day despite spending enough time in bed, the study adds a cardiovascular reason to seek evaluation. The combination of daytime sleepiness with difficulty falling asleep may indicate a hyperarousal state that puts sustained stress on the heart and blood vessels.
Clinicians evaluating hypertension risk — particularly in patients with borderline blood pressure or unexplained resistant hypertension — should ask about daytime sleepiness and sleep-onset difficulty. These symptoms may identify patients who would benefit from formal sleep evaluation, which can uncover treatable conditions like obstructive sleep apnea or chronic insomnia that contribute to both poor sleep and elevated cardiovascular risk.
The abstract was published in the journal Sleep and will be presented at the SLEEP 2026 annual meeting in Baltimore.
