Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?—a narrative review

Abstract

Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Current evidence supports the treatment of high blood pressure (BP) values in order to obtain a substantial reduction of cardiovascular burden. Sleep plays an important role in maintaining nocturnal BP control and nocturnal hypertension which, in turn, can be affected by the presence of sleep disorders. Whilst respiratory disturbances have been extensively studied and their causal role in the development of nocturnal hypertension has been demonstrated in both cross sectional and prospective studies, less is known about the impact of other sleep disorders such as insomnia. In this review, we aim to describe the role of sleep disorders in the development of nocturnal and diurnal hypertension. Furthermore, we aim to discuss the potential impact of the treatment of such sleep disorders on BP values as an adjunct treatment for patients with hypertension.

Link between respiratory pauses and vigilance states in freely moving mice

“…It raises the possibility that central sleep apneas, which affect sleep quality and are linked with cardiovascular dysfunctions (87)(88)(89), share similar mechanisms with the physiological respiratory pauses highlighted in our study. Working on the neuronal substrates involved in sleep and respiration regulation could therefore improve our understanding of the mechanisms underlying detrimental breathing disorders in sleep.…”

10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects

“…Indeed, since insomnia disorder may have a direct negative effect on cardiovascular outcome and compliance with OSAS treatments [ 54 , 55 ], the establishment of therapeutic strategies targeting only OSAS without adequate combined treatment of comorbid insomnia disorder could promote an inadequate control of the pathophysiological mechanisms favoring the occurrence of CVD in hypertensive subjects with COMISA [ 49 , 50 , 51 ]. Nevertheless, although the development of combined treatments for insomnia disorder and OSAS may open up new therapeutic options for better cardiovascular prevention in hypertensive subjects [ 56 ], the respect of some specificities of this specific subgroup of patients will be essential during the implementation of these combined therapeutic strategies of COMISA to avoid any negative impact on the conventional management of hypertension [ 57 ]. Indeed, given the potential deleterious impact of some pharmacologic approaches for insomnia disorder on blood pressure control and the limited data concerning the potential efficacy of alternatives to continuous positive airway pressure therapy to reduce blood pressure [ 58 , 59 , 60 ], the currently recommended therapeutic approach for the first-line treatment of COMISA in hypertensive subjects appears to be the combined use of cognitive behavioral therapy for insomnia and continuous positive airway pressure therapy combined with lifestyle modifications [ 6 , 57 , 61 ].…”

Letter by Pengo et al Regarding Article, “Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: Practitioner-Based Nationwide JAMP Study”

“…In addition to sleep-disordered breathing, other sleep disorders might alter the BP profile at night, such as insomnia and restless legs syndrome, which are highly prevalent in the population with hypertension. 5 In summary, we congratulate Kario and coauthors for this important study. We believe that sleep duration and, most of all, sleep disorders such as OSA should be taken into account because these could influence the relationship between…”

“…In addition to sleep-disordered breathing, other sleep disorders might alter the BP profile at night, such as insomnia and restless legs syndrome, which are highly prevalent in the population with hypertension. 5…”