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Stressed at work and trouble sleeping? It’s more serious than you think.
Antipolis, 28 April 2019:
Work stress and impaired sleep are linked to a threefold higher
risk of cardiovascular death in employees with hypertension.
That’s the finding of research published today in the European
Journal of Preventive Cardiology, a journal of the European
Society of Cardiology (ESC).1
Study author Professor Karl-Heinz Ladwig, of the German Research
Centre for Environmental Health and the Medical Faculty,
Technical University of Munich, said: “Sleep should be a time
for recreation, unwinding, and restoring energy levels. If you
have stress at work, sleep helps you recover. Unfortunately poor
sleep and job stress often go hand in hand, and when combined
with hypertension the effect is even more toxic.”
One-third of the working population has hypertension (high blood
pressure). Previous research has shown that psychosocial factors
have a stronger detrimental effect on individuals with
pre-existing cardiovascular risks than on healthy people. This
was the first study to examine the combined effects of work
stress and impaired sleep on death from cardiovascular disease in
The study included 1,959 hypertensive workers aged 25–65, without
cardiovascular disease or diabetes. Compared to those with no
work stress and good sleep, people with both risk factors had a
three times greater likelihood of death from cardiovascular
disease. People with work stress alone had a 1.6-fold higher risk
while those with only poor sleep had a 1.8-times higher risk.
During an average follow-up of nearly 18 years, the absolute risk
of cardiovascular death in hypertensive staff increased in a
stepwise fashion with each additional condition. Employees with
both work stress and impaired sleep had an absolute risk of 7.13
per 1,000 person-years compared to 3.05 per 1,000-person years in
those with no stress and healthy sleep. Absolute risks for only
work stress or only poor sleep were 4.99 and 5.95 per 1,000
In the study, work stress was defined as jobs with high demand
and low control – for example when an employer wants results but
denies authority to make decisions. “If you have high demands
but also high control, in other words you can make decisions,
this may even be positive for health,” said Professor Ladwig.
“But being entrapped in a pressured situation that you have no
power to change is harmful.”
Impaired sleep was defined as difficulties falling asleep and/or
maintaining sleep. “Maintaining sleep is the most common
problem in people with stressful jobs,” said Professor
Ladwig. “They wake up at 4 o’clock in the morning to go to the
toilet and come back to bed ruminating about how to deal with
“These are insidious problems,” noted Professor Ladwig.
“The risk is not having one tough day and no sleep. It is
suffering from a stressful job and poor sleep over many years,
which fade energy resources and may lead to an early grave.”
"The findings are a red flag for doctors to ask patients
with high blood pressure about sleep and job strain",
said Professor Ladwig. “Each condition is a risk factor on its
own and there is cross-talk among them, meaning each one
increases risk of the other. Physical activity, eating healthily
and relaxation strategies are important, as well as blood
pressure lowering medication if appropriate.”
Employers should provide stress management and sleep treatment in
the workplace, he added, especially for staff with chronic
conditions like hypertension.
Components of group stress management sessions:
Start with 5 to
10 minutes of relaxation.
Help with smoking
cessation, physical exercise, weight loss.
cope with stress and anxiety at home and work.
How to monitor
progress with stress management.
relationships and social support.
Sleep treatment can include:
training to associate the bed/bedroom with sleep and set a
consistent sleep-wake schedule.
progressive muscle relaxation, and reducing intrusive
thoughts at bedtime that interfere with sleep.
curtailing the period in bed to the time spent asleep,
thereby inducing mild sleep deprivation, then lengthening
remaining passively awake and avoiding any effort (i.e.
intention) to fall asleep, thereby eliminating anxiety.