Sleep Apnea and Insomnia Together May Be Associated With Poorer Blood Pressure Control

According to a Swedish population study, people who had both insomnia and obstructive sleep apnea were more likely to have uncontrolled blood pressure. The results suggest that clinicians may get a clearer picture by asking about both sleep problems instead of looking at breathing disturbances or sleeplessness on their own.

Obstructive sleep apnea causes repeated pauses in breathing during sleep. Insomnia refers to ongoing trouble falling asleep, staying asleep, or waking too early, along with daytime impairment. In some people, the two conditions occur together.

Researchers at the University of Gothenburg studied 3,832 middle-aged adults in the Swedish CardioPulmonary BioImage Study. Participants received health assessments, blood pressure checks, and an at-home sleep-breathing test.

The researchers also used a questionnaire to identify significant insomnia symptoms. By combining those results, they could compare people with neither condition, insomnia alone, apnea alone, and both conditions.

Uncontrolled hypertension was recorded in 10.2% of participants with both conditions, compared with 7.9% of those with apnea alone. The figures were 4.5% for insomnia alone and 4.4% for the comparison group.

These percentages reflect blood pressure readings that met the study’s definition of uncontrolled hypertension, not the share of people ever diagnosed with high blood pressure. Some participants had hypertension that was kept in check with medication.

The study, published in the Annals of the American Thoracic Society, defined uncontrolled hypertension as an office reading of at least 140 systolic or 90 diastolic. That threshold is important when comparing the findings with research that uses different blood pressure cutoffs.

After adjusting for several measured factors, the group with both sleep conditions still had higher odds of uncontrolled blood pressure than the comparison group. Participants with apnea alone also showed an association.

The researchers found that time spent with low oxygen during sleep explained part of the connection. Repeated breathing interruptions and disrupted sleep raise biological questions for further study, but the analysis does not show exactly what caused the blood pressure differences.

Because the study looked at participants at a single point in time, it cannot prove that the sleep problems came first. It also did not test whether treating both conditions lowers blood pressure more than treating either one alone.

That remains a practical question for future trials. Someone receiving treatment for sleep apnea may still struggle with insomnia, and identifying both issues could help clinicians shape care around the full sleep disorder picture.

The findings support a broader evaluation when sleep difficulties and hypertension appear together. They offer a reason to look for both breathing pauses and persistent sleeplessness, while the benefit of combined treatment still needs to be established.

Source: University of Gothenburg.