Insomnia poses hypertension risk

Sep 16 2013

By Lucy Piper, Senior medwireNews Reporter

Insomnia may be associated with an increased risk for hypertension, research from China suggests.

Short sleep duration and the insomnia symptoms of difficulty maintaining sleep and early-morning awakening, as well as combined symptoms of insomnia were associated with an increased risk. By contrast, there was less evidence to support an association between long sleep duration or difficulty falling asleep and hypertension incidence.

The findings stem from a meta-analysis of 11 research studies, involving 58,924 participants assessed for sleep duration or insomnia over average follow-up periods of 5.5 years and 8.12 years, respectively.

The magnitude of increased risk for hypertension incidence ranged from 1.14-fold for individuals with early-morning awakening to 1.20-fold for those with difficulty maintaining sleep and 1.21-fold for those with short sleep duration (<5 or 6 hours per night), while insomnia symptoms combined increased the risk 1.05-fold.

Lead researcher Yang Zheng (Bethune First Hospital of Jilin University, Changchun) and colleagues therefore say: “It is important to consider sleep duration and insomnia in hypertension prevention and treatment.”

They note in Hypertension Research, however, that the association between insomnia and hypertension was attenuated somewhat when other sleep disorders were considered.

This means that “the association… could be partly explained by other sleep disorders, such as untreated sleep apnea with insomnia or that the variance explained by insomnia overlaps, even if it is genuinely caused by the insomnia,” say Zheng and co-workers.

They suggest that there are a number of physiologic effects of sleep deprivation that could contribute to the increased risk for hypertension, including overactivity of the renin–angiotensin–aldosterone system, proinflammatory responses, endothelial dysfunction, renal impairment, and alteration of the circadian rhythm.

“More laboratory studies are needed to further detect potential biological mechanisms,” they write.

In a related commentary, Michael Grandner and Michael Perlis, from the University of Pennsylvania in Philadelphia, USA, say that the findings highlight “that the adverse outcomes of insomnia, as well as short sleep duration, go beyond the behavioral, psychological or functional domains and include important medical consequences as well.”

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