Published: 2017-02-20

A cross-sectional, multi-centric, epidemiology study to determine the prevalence of insomnia and related sleep habits in Indian hypertensive patients

Rajiv Karnik, Karthik Peethambaran, Samir Adsule


Background: Hypertension is a leading risk factor affecting mortality and disability-adjusted life years worldwide. The objective of the study was to determine the prevalence of insomnia, co-morbid medical conditions, lifestyle attributes, related sleep habits and sleep quality among Indian hypertensive patients.

Methods: Adults (≥18 years) with newly diagnosed or known history of hypertension, willing to participate were enrolled in this cross-sectional, epidemiological study. Several variables including lifestyle attributes, sleep habits, quality, medications, demographics, medical/surgical history and other details pertaining to hypertension were analyzed. Insomnia was assessed by Athens Insomnia Scale (AIS) in patients not identified in the past one month.

Results: All the 657 enrolled patients completed the study (mean age: 55.4±11.61 years; men: 53.7%; women: 46.3%). Prevalence of insomnia among hypertensive population was approximately 47.2% (n=310; 95% CI: 43.4, 51.0). Number of patients newly diagnosed with insomnia by AIS scale was higher compared with patients already diagnosed with insomnia (34.9% [95% CI: 31.2, 38.5] vs. 12.3% [95% CI: 9.81, 14.8]). Common medical conditions associated with hypertension were diabetes mellitus (61.1%) and dyslipidemia (28.3%). More than half of the hypertensive patients with insomnia had sleep-related problems once or twice a week. Further, the daytime impact of insufficient sleep on wellbeing and functioning was markedly decreased in insomniac patients.

Conclusions: Prevalence of insomnia among patients suffering from hypertension was higher than that reported in general Indian population in various studies. Present study shows that about 75% insomniac cases were undiagnosed, indicating that insomnia diagnosis may have been missed in a large proportion of hypertensive patients.


AIS, Hypertension, India, Insomnia

Full Text:



World Health Organization: Global health risks: mortality and burden of disease attributable to selected major risks. 2009. Accessed on 12 December 2016.

Chockalingam A, Campbell NR, Fodor JG. Worldwide epidemic of hypertension. Can J Cardiol. 2006;22(7):553-5.

Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32(6):1170-7.

Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004;18(2):73-8.

Basta M, Chrousos GP, Vela-Bueno A, Vgontzas AN. Chronic insomnia and stress system. Sleep med clin. 2007;2(2):279-91.

Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22(2):S347-53.

Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262(11):1479-84.

Yardi N, Adsule S. A cross-sectional observational study to determine the prevalence of insomnia amongst Indian corporate employees. J Assoc Physicians India. 2015;63(10):20-5.

Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India. 2012;60(1):68-74.

Roy SK, Bhattacharjee AK, Chakraborti C, Singh R. Prevalence of insomnia in urban population of West Bengal: A community-based cross-sectional study. Int J Med Public Health. 2015;5(4):293-6.

Calhoun DA, Harding SM. Sleep and Hypertension. Chest. 2010;138(2):434-43.

Phillips B, Mannino DM. Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med. 2007;3(5):489-94.

Lanfranchi PA, Pennestri MH, Fradette L, Dumont M, Morin CM, Montplaisir J. Nighttime blood pressure in normotensive subjects with chronic insomnia: implication for cardiovascular risk. Sleep. 2009;32(6):760-6.

Zhan Y, Chen R, Zhang F, Wang J, Sun Y, Ding R, et al. Insomnia and its association with hypertension in a community-based population in China: a cross-sectional study. Heart Asia. 2014;6(1):88-93.

Palagini L, Bruno RM, Gemignani A, Baglioni C, Ghiadoni L, Riemann D. Sleep loss and hypertension: a systematic review. Curr Pharm Des. 2013;19(13):2409-19.

Bonnet MH. Evidence for the pathophysiology of insomnia. Sleep. 2009;32(4):441-2.

Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res. 2000;48(6):555-60.

Sen P, Mukhopadhyay AK, Chatterjee P, Biswas T. Association of Sleep Disorders with Essential Hypertension in Subcontinental Population. Indian Medical Gazette. 2012:463-6.

Piwonski J, Piotrowski W, Prejbisz A. Prevalence of insomnia in the Warsaw metropolitan area (Pol-Monica Bis) - Relationship to hypertension and other cardiovascular risk factors. J Hypertens. 2003;21(1): S171.

Prejbisz A, Kabat M, Januszewicz A, Szelenberger W, Piotrowska AJ, Piotrowski W, et al. Characterization of insomnia in patients with essential hypertension. Blood Press. 2006;15(4):213-9.

Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5):S7-10.

Brook JS, Zhang C, Seltzer N, Brook DW. Insomnia in adults: the impact of earlier cigarette smoking from adolescence to adulthood. J Addict Med. 2015;9(1):40-5.

Vgontzas AN, Lin HM, Papaliaga M, Calhoun S, Vela-Bueno A, Chrousos GP, et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J Obes (Lond). 2008;32(5):801-9.

Brook DW, Rubenstone E, Zhang C, Brook JS. Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life. Sleep Med. 2012;13(9):1130-7.

Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, et al. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014;19(3):486-96.

Jaehne A, Unbehaun T, Feige B, Lutz UC, Batra A, Riemann D. How smoking affects sleep: a polysomnographical analysis. Sleep Med. 2012;13(10):1286-92.

Liu JT, Lee IH, Wang CH, Chen KC, Lee CI, Yang YK. Cigarette smoking might impair memory and sleep quality. J Formos Med Assoc. 2013;112(5):287-90.

Sabanayagam C, Shankar A. The association between active smoking, smokeless tobacco, second hand smoke exposure and insufficient sleep. Sleep med. 2011;12(1):7-11.

Pomerleau OF. Nicotine and the central nervous system: biobehavioral effects of cigarette smoking. Am J Med. 1992;93(1A):2S-7S.

Ohida T, Kamal AM, Uchiyama M, Kim K, Takemura S, Sone T, et al. The influence of lifestyle and health status factors on sleep loss among the Japanese general population. Sleep. 2001;24(3):333-8.

Sherrill DL, Kotchou K, Quan SF. Association of physical activity and human sleep disorders. Arch Intern Med. 1998;158(17):1894-8.

Youngstedt SD, Kline CE. Epidemiology of exercise and sleep. Sleep Biol Rhythms. 2006;4(3):215-21.

Youngstedt SD, Kline CE. Epidemiology of exercise and sleep. Sleep and biological rhythms.2006;4(3):215-221.

Ishak WW, Bagot K, Thomas S, Magakian N, Bedwani D, Larson D, et al. Quality of Life in Patients Suffering from Insomnia. Innov Clin Neurosci. 2012;9(10):13-26.

Consensus statement on the management of insomnia. Mosby, Saunders, Churchill Livingstone, Butterworth Heinemann and Hanley and Belfus. 2013.

National Institute of Health. Insomnia: Assessment and management in primary care. 1998. Available at: insom_pc.htm. Assessed on 22 September 2016.

Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. An american academy of sleep medicine review. Sleep. 1999;22(8):1134-56.

Perlis ML, Youngstedt SD. The diagnosis of primary insomnia and treatment alternatives. Compr Ther. 2000;26(4):298-306.

Kapur VK, Redline S, Nieto FJ, Young TB, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289-96.

Buysse DJ. Insomnia. JAMA. 2013;309(7):706-16.