Association between weekend catch-up sleep and hypertension in U.S. middle-aged and older adults: Insights from NHANES 2017–2023

Weekend catch-up sleep (WCS) has been proposed as a compensatory mechanism to mitigate the adverse cardiovascular effects of weekday sleep deprivation. However, evidence regarding its association with hypertension remains limited and inconsistent, particularly among middle-aged and older adults. Data were obtained from National Health and Nutrition Examination Survey 2017–2023, including 11,934 U.S. adults aged ≥ 40 years. WCS was calculated as the difference between self-reported weekend and weekday sleep duration. Hypertension was defined based on self-reported diagnosis, medication use, or measured blood pressure. Multivariable logistic regression was used to assess the association between WCS and hypertension. Subgroup analyses were performed by sex and weekday sleep duration. Compared to participants with no WCS (<0 hours), those with 0 to 2 hours and ≥ 2 hours of WCS had significantly lower odds of hypertension (odds ratios [OR]: 0.82, 95% confidence intervals [CI]: 0.71–0.93; OR: 0.77, 95% CI: 0.65–0.90, respectively). A consistent inverse association was observed in males, especially among those with ≥ 2 hours of WCS (OR: 0.68, 95% CI: 0.54–0.86), while the association in females was not statistically significant after full adjustment. Among individuals with > 7 hours of weekday sleep, a clear dose–response relationship was identified between WCS duration and reduced hypertension risk (≥2 hours: OR: 0.64, 95% CI: 0.50–0.81), whereas no significant protective effect was found in those with ≤ 7 hours of weekday sleep. In U.S. middle-aged and older adults, moderate to extended WCS is associated with a reduced risk of hypertension, particularly among males and those with sufficient weekday sleep. These findings highlight the potential role of WCS in cardiovascular risk management and underscore the importance of considering baseline sleep patterns and sex differences in sleep-related interventions.