Dr. Alexandros Vgontzas was studying sleep when he and his team at Penn State College of Medicine uncovered something striking: people who struggle to fall asleep and feel exhausted during the day face a dramatically elevated risk of high blood pressure. The combination matters far more than either problem alone.
The research, drawn from 1,741 adults in the Penn State Adult Cohort and presented at SLEEP 2026, reveals a hidden cardiovascular danger that slips past standard screening. For years, doctors have known that excessive daytime sleepiness and sleep problems are linked to heart health. But Vgontzas's findings suggest that when these two conditions occur together, they create a distinct and dangerous pattern—one that clinical practice has yet to fully recognize.
The numbers tell a sobering story. Adults reporting excessive daytime sleepiness had 52% higher odds of existing high blood pressure and 74% higher odds of developing it over time compared to those sleeping normally. But the real warning emerges when researchers combined this with objective data from polysomnography tests—standard sleep studies that measure exactly how long it takes someone to drift off. When excessive daytime sleepiness occurred alongside prolonged sleep-onset latency of 30 minutes or more, odds of prevalent hypertension more than doubled, and odds of incident hypertension more than tripled.
"Neither excessive daytime sleepiness on its own nor prolonged sleep latency on its own showed the same increased risk of hypertension," Vgontzas explained. The distinction is crucial. It means a person could have either problem—waking up groggy, or tossing for half an hour before sleep arrives—without facing the same cardiovascular danger. But together, they form what researchers now recognize as a distinct clinical phenotype requiring targeted attention.
The study followed 786 participants without hypertension at baseline for an average of 7.5 years, controlling for multiple variables including body mass index, smoking, caffeine and alcohol use, diabetes, depression, and sleep apnea severity. This rigor matters because it shows the finding holds up even after accounting for other major health factors. Excessive daytime sleepiness was defined by self-reported moderate-to-severe daytime sleepiness or irresistible sleep attacks—the kind that makes staying awake during meetings or conversations genuinely difficult. Prolonged sleep-onset latency measured the objective reality: people literally lying in bed for 30 minutes or more before falling asleep.
For patients and physicians alike, the implications are practical and immediate. Current screening often focuses narrowly on sleep apnea when daytime sleepiness appears. But Vgontzas's work suggests a broader lens is needed. Evaluating nighttime sleep difficulties—how long it actually takes to fall asleep—alongside daytime symptoms could help identify people at serious cardiovascular risk before problems develop. This opens a pathway to more targeted treatments: not just a sleep apnea diagnosis, but recognition of a specific sleep disturbance pattern that demands intervention.
The American Academy of Sleep Medicine already recommends that adults prioritize healthy sleep as part of overall cardiovascular health. These findings add precision to that guidance. For anyone lying awake at night and drowsy during the day, the message is clear: this combination deserves medical attention, not dismissal as normal aging or stress.