Abstract
BackgroundInsomnia disorder is a widespread sleep disorder with a prevalence of approximately 10%. Even though the link between insomnia and cardiovascular activity is not exactly clear, it is generally assumed that cardiovascular autonomic modifications could occur as a result of sleeplessness, or, alternatively, that autonomic alterations could be an expression of a hyper-arousal state. This review investigates whether cardiovascular measures are different between insomniacs and controls.MethodsElectronic databases were systematically searched, and 34 studies were identified. Heart rate variability features, the association of cardiac and EEG activity, physiologic complexity measures, and cardiovascular activity, assessed by measures such as pre-ejection time, blood pressure, and heart rate dynamics were studied. Given the heterogeneity of the studies, a narrative synthesis of the findings was performed.ResultsThis review study found overall differences in cardiovascular activity between insomniacs and controls in most of the observational studies (21/26), while the expression of cardiovascular regulation varied between the examined insomniac groups. All the studies that investigated the association of cardiac activity and EEG power reported an altered relation between autonomic activity and EEG parameters in insomniacs.ConclusionAutonomic regulation tends to be consistent between insomniacs, as long as they are grouped according to their respective phenotype, as shown in the insomnia subgroup with objectively short sleep duration. Our hypothesis is that these differences in the expression of cardiovascular activity could be explained by the heterogeneity of the disorder. Therefore, the determination of insomnia phenotypes, and the study of cardiovascular measures, rather than heart rate variability alone, will give more insight into the link between insomnia and cardiovascular regulation. This study suggests that cardiovascular activity differs between insomniacs and controls. These new findings are of interest to clinicians and researchers for a more accurate insomnia assessment, and the development of personalized technological solutions in insomnia.
Highlights
Difficulties initiating or maintaining sleep are very prevalent sleep complaints in the general population [1, 2]
All the studies that investigated the association of cardiac activity and EEG power reported an altered relation between autonomic activity and EEG parameters in insomniacs
Autonomic regulation tends to be consistent between insomniacs, as long as they are grouped according to their respective phenotype, as shown in the insomnia subgroup with objectively short sleep duration
Summary
Difficulties initiating or maintaining sleep are very prevalent sleep complaints in the general population [1, 2]. Multinational studies that used the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria reported prevalence rates of insomnia disorder that range from 3.9% to 22.1%, with an average of approximately 10% [3] This is a broad range that reflects different modalities of investigation and the population under study [1]. On the latest update of DSM, insomnia disorder is defined as a predominant complaint of dissatisfaction with sleep quality or duration and is accompanied by difficulties in initiating sleep at bedtime, frequent or prolonged awakenings, or early-morning awakening, with an inability to return to sleep [4] This sleep disturbance causes clinically significant social, occupational, educational, academic, and behavioral distress or impairment. This review investigates whether cardiovascular measures are different between insomniacs and controls
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