Risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in chronic insomnia: A study on 1272 individuals referred for polysomnography

Abstract

Given conflicting data in the literature, the aim of this study was to examine the risk of hypertension associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of insomnia sufferers. Demographic and polysomnographic data from 1272 insomnia sufferers recruited from the research database of the sleep laboratory were analyzed. Hypertension status was defined by the presence of one of the following: self-report at interview of either a physician's diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥ 140 mm Hg or an average diastolic blood pressure ≥ 90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in insomnia sufferers. The prevalence of hypertension in insomnia sufferers is 30.03%. After adjustment for major confounding factors associated with hypertension, multivariate logistic regression analysis revealed that short sleep duration (< 5 hours) [OR 1.91 (95% CI 1.15–3.16)], severely reduced sleep efficiency (< 65%) [OR 1.57 (95% CI 1.01–2.45)], high sleep fragmentation (sleep fragmentation index ≥ 18/hour) [OR 1.59 (95% CI 1.10–2.30)], and long-term use of short [OR 1.78 (95% CI 1.03–3.09)] or intermediate [OR 2.10 (95% CI 1.12–3.92)] half-life benzodiazepine receptor agonists were significant risk factors of hypertension in insomnia sufferers. In insomnia sufferers, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of hypertension. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and hypertension.