ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 15 of 67
УЖМБС 2020, 5(4): 124–130
Clinical Medicine

The Relationship between Antihypertensive Therapy and Sleep Disorders in Patients with Hypertension and Diabetes Mellitus Type 2

Buriakovska Olena

Sleep disorders are one of the leading complaints of patients with cardiovascular diseases. However, little is reported on interrelations between insomnia, excessive daytime sleepiness as its consequence, metabolic parameters and cardiovascular risks in patients with hypertension. Sleep disorders are one of the risk factors of cardiovascular diseases. At the same time, more than 40% of patients with established diseases of the cardiovascular system have problems with the quality or duration of sleep. The purpose of this study was to find the relationship between antihypertensive therapy and sleep disorders in patients with an isolated course of hypertension and its combination with type 2 diabetes mellitus. Material and methods. A cross-sectional study was conducted. The study included 38 patients with an isolated hypertension, 82 patients with its combination with type 2 diabetes and 23 healthy volunteers. Exclusion criteria included the history of myocardial infarction or stroke, cardiac insufficiency or ejection fraction below 45%, resistant arterial hypertension, abnormal thyroid function, onsets of peptic or duodenal ulcer diseases, co-morbidities that affect the quality of life, obesity stage 3, any active oncological diseases, insomnia as a symptom of any psychic disorder, treatment with glucocorticosteroids, moxonidine, reserpine, β-blockers, hypnotic drugs, nocturnal food intake, and obstructive sleep apnea. Body mass index (kg/m2) was assessed. Insomnia was diagnosed in accordance with the International Classification of Sleep Disorders – Third Edition (ICSD-3). To detect obstructive sleep apnea, a portable monitoring device SOMNOcheck micro CARDIO (2013, Germany) was used. Statistical analysis was performed using SPSS 17.0 software. Data are presented as the mean (M) and standard deviation (SD) in case of normal distribution and as the median and interquartile range (25% and 75%) if the distribution is not normal. Numerical values are shown as the number (n) and percentage (%). To compare independent groups of variables, either Student’s test or Mann-Whitney test was used. When comparing more than two groups, ANOVA test was selected. Results and discussion. The study showed that insomnia prevailed in the group of patients with hypertension (p=0.05), whereas in the combined course of hypertension and type 2 diabetes mellitus, circadian rhythm sleep-wake disorders (p=0.028), as well as obstructive sleep apnea. Antihypertensive therapy in the groups was comparable in composition and dose. It was revealed that among patients with an isolated course of hypertension receiving amlodipine (p=0.05) and valsartan (p=0.04), insomnia was significantly less diagnosed. When calculating the odds ratio, weobserved that the risk of early awakenings and the difficulty of maintaining sleep was significantly lower in the group of patients treated with amlodipine (p=0.005). Conclusion. The patients with an isolated course of hypertension and with its combination with type 2 diabetes mellitus had significantly more frequent sleep disorders than the control group patients. Amlodipine was associated with a lower incidence of insomnia symptoms.

Keywords: insomnia, amlodipine, early awakenings, difficulty of maintaining sleep

Full text: PDF (Ukr) 480K

  1. Cappuccio FP, Miller MA. Sleep and Cardio-Metabolic Disease. Curr Cardiol Rep. 2017; 19(11): 110.
  2. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007; 30(7): 213-8.
  3. Zucconi M, Ferri R. Chapter B. Assessment of sleep disorders and diagnostic procedures. 1. Classifi cation of sleep disorders. In: Sleep Medicine Textbook. Regensburg: ESRS; 2014. p. 95-110.
  4. Van Ryswyk E, Mukherjee S, Chai-Coetzer CL, Vakulin A, McEvoy RD. Sleep Disorders, Including Sleep Apnea and Hypertension. Am J Hypertens. 2018; 31(8): 857-64.
  5. Calhoun DA. Sleep disorders and hypertension risk. J Hum Hypertens. 2017; 31(6): 371-2. 10.1038/jhh.2017.2
  6. Thomas SJ, Calhoun D. Sleep, insomnia, and hypertension: current findings and future directions. J Am Soc Hypertens. 2017; 11(2): 122-9.
  7. Winkelman JW, Benca R, Eichler AF. Overview of the treatment of insomnia in adults. 2020. Available from:
  8. Petrov ME, Howard VJ, Kleindorfer D, Grandner MA, Molano JR, Howard G. Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study. J Stroke Cerebrovasc Dis. 2014; 23(8): 2110-6.
  9. Hernández-Aceituno A, Guallar-Castillón P, García-Esquinas E, Rodríguez-Artalejo F, Banegas JR. Association between sleep characteristics and antihypertensive treatment in older adults. Geriatr Gerontol Int. 2019; 19(6): 537-40.
  10. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. Authors/Task Force Members: 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953-2041.
  11. Nakaz MOZ № 1118 vid 21.12.2012. Unifikovanyi klinichnyi protokol pervynnoi ta vtorynnoi (spetsializovanoi) medychnoi dopomohy: tsukrovyi diabet 2 typu [Unified clinical protocol of primary and secondary (specialized) medical care: type 2 diabetes mellitus]. [Ukrainian]
  12. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014; 146(5): 1387-94.
  13. Samizo K, Kawabe E, Hinotsu S, Sato T, Kageyama S, Hamada C, et al. Comparison of losartan with ACE inhibitors and dihydropyridine calcium channel antagonists: a pilot study of prescription-event monitoring in Japan. Drug Saf. 2002; 25(11): 811-21.
  14. Gan'shina TS, Kim GA, Gnezdilova AV, Kurdiumov IN, Mirzoian RS. [Effect of S-amlodipine nicotinate on the cerebral circulation in rats under conditions of ischemic and hemorrhagic brain injury]. Eksp Klin Farmakol. 2014; 77(9): 3-7. [Russian]
  15. Laffin LJ, Bakris GL. Hypertension and new treatment approaches targeting the sympathetic nervous system. Curr Opin Pharmacol. 2015; 21: 20-4.