{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:36:58Z","timestamp":1794278218923,"version":"4.9.0"},"reference-count":58,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,10]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the associations between sleep quality and left ventricular hypertrophy (LVH) and their associations with haemodynamic and cardiometabolic risk factors among adults with hypertension in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional analytical study conducted from February to July 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Conducted in three tertiary care hospitals in Sialkot, Pakistan representing both urban and rural populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 405 participants aged \u226530 years, diagnosed with hypertension, were enrolled. Patients with primary sleep disorders, psychiatric illness, pregnancy or incomplete data were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Sleep quality was assessed using the Urdu version of the Pittsburgh Sleep Quality Index (PSQI) with a cut-off \u22655. Blood pressure was measured as the average of three seated readings. LVH was determined by echocardiography. Modified Poisson regression with robust SEs was applied to estimate adjusted prevalence ratios (aPRs) for factors associated with LVH and poor sleep, accounting for clustering by hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LVH was present in 38.3% of participants, and 68.4% had poor sleep quality. In fully adjusted models for LVH, poor sleep quality was not independently associated with LVH (aPR 1.11; p=0.512).<\/jats:p>\n                    <jats:p>Independent associates of LVH included:<\/jats:p>\n                    <jats:p>Age (aPR=1.32; p&lt;0.001).<\/jats:p>\n                    <jats:p>Systolic blood pressure (aPR=1.021 per mm Hg; p&lt;0.001).<\/jats:p>\n                    <jats:p>Diastolic blood pressure (aPR=1.030 per mm Hg; p&lt;0.001).<\/jats:p>\n                    <jats:p>Longer hypertension duration (aPR=1.47; p=0.002).<\/jats:p>\n                    <jats:p>Overweight (aPR=0.77) and obesity (aPR=0.71) were inversely associated with LVH, consistent with the obesity paradox. Poor sleep quality was independently associated with smoking status, longer hypertension duration and higher blood pressure. Sensitivity analyses treating PSQI as a continuous variable (aPR=1.033 per point) suggested a modest dose\u2013response relationship between more severe sleep impairment and LVH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated blood pressure, longer hypertension duration and smoking were significantly associated with LVH and poor sleep quality. Sleep quality was not an independent correlate of LVH, suggesting an indirect relationship mediated through haemodynamic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109265","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T11:08:16Z","timestamp":1771326496000},"page":"e109265","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Associations of left ventricular hypertrophy and poor sleep quality with haemodynamic and cardiometabolic risk factors in adults with hypertension: a cross-sectional study from Pakistan"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9825-4933","authenticated-orcid":false,"given":"Muhammad Saad","family":"Nadeem Butt","sequence":"first","affiliation":[{"name":"Islam Medical and Dental College, Sialkot, Pakistan"},{"name":"Islam Medical and Dental College, Sialkot, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Shafique","sequence":"additional","affiliation":[{"name":"Islam Medical and Dental College, Sialkot, Pakistan"},{"name":"Islam Medical and Dental College, Sialkot, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad","family":"Iqbal Burq","sequence":"additional","affiliation":[{"name":"Community Medicine, Islam Medical and Dental College, Sialkot, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2026010307034948000_15.12.e109265.1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15026"},{"key":"2026010307034948000_15.12.e109265.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-019-0244-2"},{"key":"2026010307034948000_15.12.e109265.3","doi-asserted-by":"crossref","unstructured":"Mirzaei M , Mirzaei M , Bagheri B , et al . 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