Elsevier

Sleep Medicine Reviews

Volume 41, October 2018, Pages 3-38
Sleep Medicine Reviews

Clinical review
Insomnia and hypertension: A systematic review

https://doi.org/10.1016/j.smrv.2018.02.003Get rights and content

Summary

Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease and its precursors, such as hypertension and blood pressure (BP) non-dipping. The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension and/or BP. Using electronic search engines (PubMed, SCOPUS, PsycINFO), 5,618 articles published from January 1970 to December 2017 were identified, and 64 met the inclusion criteria (26 to 162,121 participants; age range: 18–100; 46.4% male). Insomnia was based on diagnostic or non-diagnostic criteria. Hypertension was based on self-or physician-reports, antihypertensive medication use, and/or measured BP. Findings indicate that when insomnia is frequent, chronic, and/or accompanied with short sleep duration or objective markers of arousal, there is a strong association with hypertension/BP. Based on limited studies, hypertension did not significantly predict future insomnia in middle-aged adults, but did in older adults. Based on a majority of case–control studies, no differences in BP were found between participants with and without insomnia. Further research is needed to identify putative pathophysiological mechanisms underlying the link between insomnia and hypertension. The impact of insomnia therapy on BP should also be further examined in the future.

Section snippets

Insomnia

Insomnia is a prevalent sleep disorder affecting 20%–25% of adults on a situational basis and 10%–12% on a chronic basis [1]. Insomnia is a dynamic construct comprised of a spectrum of sleep complaints, including difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS) (e.g., frequent and/or prolonged nocturnal awakenings), and/or early morning awakening (EMA) with an inability to return to sleep. While previous diagnostic criteria also included non-restorative sleep (NRS), a

Hypertension and BP dipping

Hypertension affects 20%–30% of adults and is defined as systolic BP (SBP) ≥140 mmHg and diastolic BP (DBP) ≥90 mmHg [9]. Under normal conditions, BP fluctuates and follows a circadian pattern that is characterized by considerably lower nocturnal mean BP values compared with diurnal mean BP values (∼10%–20%). A lack in this attenuation (<10%) is abnormal and is referred to as BP non-dipping [9]. Hypertension and BP non-dipping each increase the risk with current and future cardiovascular

Insomnia, hypertension, and BP dipping

Over the years, research has shown that poor sleep quality, sleep curtailment, and sleep disorders (e.g., sleep apnea) are linked with hypertension and with BP non-dipping ∗[3], [4], [5], [6], [11]. Specifically, insomnia syndrome and/or its individual symptoms are proposed to play a contributory role in hypertension ∗[3], [4], [5], [6], [11]. Indeed, evidence dating back to the 1970s already identified differences in somatic, psychological, and physiological characteristics between individuals

Literature search

In line with the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement [24], an electronic systematic search of PubMed, SCOPUS, and PsycINFO was performed to identify articles that examined the associations between insomnia with hypertension and BP dipping. Medical subject headings (MeSH) and keywords included “Insomnia” OR “Chronic Insomnia” OR “DIMS, Disorders of Initiating and Maintaining Sleep” OR “Disorders of Initiating and Maintaining Sleep” OR “Early

Study selection

A total of 5,618 articles were identified (PubMed: n = 1,501; SCOPUS: n = 3,778; PsycINFO: n = 339). Screening of reference lists from eligible studies and review articles were crosschecked and nine additional studies were identified. From these, 789 duplicates were removed, leaving 4,838 articles to be considered for inclusion in the review (see Fig. 1). From this initial screening, which included reading the title and abstract, 2,929 articles were excluded, as they did not meet the study

Discussion

The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension, BP, and/or BP dipping. When examining the risk of insomnia among those with hypertension relative to those without hypertension, cross-sectional evidence consistently showed that when self-reported hypertension was used, there was a positive association with ORs ranging from 1.07 to 1.92, regardless of whether insomnia was based on diagnostic [21], ∗[55]

Acknowledgements

This study was supported by the Fonds de recherche du Québec - Santé (32207) awarded to Denise C. Jarrin. Christopher L. Drake has served as a consultant for Teva; has received research support from Merck and Teva; and has served on a speakers bureau for Jazz, Purdue, and Teva. Charles M. Morin has served as a consultant for Merck and Cereve. The remaining authors report no conflict of interest associated with material presented in this review. A sincere thank you to Vivian Isabel Jarrin and

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