Effects of insomnia and restless legs syndrome on sleep arterial blood pressure: A systematic review and meta-analysis

• Published in: Sleep medicine reviews Vol. 59; p. 101497
• Main Authors: Maiolino, Giuseppe, Bisogni, Valeria, Soranna, Davide, Pengo, Martino F., Pucci, Giacomo, Vettor, Roberto, Fava, Cristiano, Colussi, Gian Luca, Bilo, Grzegorz, Lombardi, Carolina, Parati, Gianfranco, Rossi, Gian Paolo, Silvani, Alessandro
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2021
• Subjects: Arterial Pressure; Blood Pressure; Blood pressure dipping; Humans; Insomnia; Neurology; Nocturnal hypertension; Restless Legs Syndrome; Sleep; Sleep blood pressure; Sleep Initiation and Maintenance Disorders; Sleep Medicine; ABPM; PICO; Sleep blood pressure; AHI; CI; PLMS; PRISMA; BP; WASO; Restless legs syndrome; ESC; Insomnia; Nocturnal hypertension; Blood pressure dipping; RLS; PROSPERO; ESH; OSA; BMI; periodic leg movements during sleep; preferred reporting items for systematic reviews and meta-analyses; European Society of Hypertension; apnea/hypopnea index; prospective register of systematic reviews; blood pressure dipping; patient problem, intervention, comparison, outcome; nocturnal hypertension; obstructive sleep apnea; blood pressure; restless legs syndrome; body mass index; wakefulness after sleep onset; insomnia; ambulatory blood pressure monitoring; European Society of Cardiology; confidence interval; sleep blood pressure
• ISSN: 1087-0792; 1532-2955; 1532-2955
• DOI: 10.1016/j.smrv.2021.101497

Hypertension and blunted blood pressure (BP) dipping during nighttime sleep are associated with increased cardiovascular risk. Chronic insomnia and restless legs syndrome (RLS) may affect the 24-h BP profile. We systematically reviewed the association of insomnia and RLS with BP values during nighttime sleep and the relative BP dipping pattern. We searched relevant articles in any language with selection criteria including enrolment of subjects with insomnia or RLS and with obstructive sleep apnea comorbidity assessment. Of the 872 studies originally retrieved, seven were selected. Four studies enrolled subjects with insomnia. One study relied on sleep diaries to classify nighttime sleep BP, whereas three relied only on clock time. At meta-analysis, subjects with insomnia displayed an attenuated dipping of systolic BP (−2.00%; 95% confidence interval (CI): −3.61 - −0.39%) and diastolic BP (−1.58%; 95% CI: −2.66 ̶ −0.49%) during nighttime sleep compared to controls. Three studies enrolled subjects with RLS. One study relied on polysomnography to classify nighttime sleep BP, whereas two relied only on clock time. Subjects with RLS showed increases in nighttime sleep systolic BP (5.61 mm Hg, 95% CI 0.13̶–11.09 mm Hg) compared to controls. In conclusion, the limited available data suggest that insomnia and RLS are both associated with altered BP control during nighttime sleep. There is need for more clinical studies to confirm these findings, specifically focusing on measurements of BP during objectively defined sleep, on causal roles of leg movements during sleep and alterations in sleep architecture, and on implications for cardiovascular risk. CRD42020217947.