Insomnia and Hypertension: Importance of Objective Phenotyping and Comorbidity with Sleep Apnea

PURPOSE OF REVIEW: Provide a synthesis of research from the past five years examining the relationship between insomnia, its phenotypes, and comorbidity with sleep apnea (COMISA), with hypertension. Offer a critical evaluation of current evidence and outline future research directions. RECENT FINDINGS: Meta-analytic evidence indicates that the risk of hypertension is higher in patients with insomnia disorder compared to those with insomnia symptoms, with the highest risk observed in the insomnia with objective short sleep duration phenotype. COMISA appears to further amplify this risk, although the evidence is limited to individual studies with no meta-analyses available. There is a clear need for clinical trials to confirm these associations and guide the development of more effective therapeutic strategies. Insomnia should be part of the diagnostic assessment of patients with hypertension. Objective sleep duration can serve as a biomarker, alongside respiratory indices, to guide therapeutic decision-making and optimize patient management.