Effect of behavioural sleep interventions on blood pressure, heart rate, and heart rate variability in adults with poor sleep health: a systematic review, meta-analysis, and meta-regression analysis

Abstract Background Poor sleep health is known to negatively impact cardiovascular risk factors, including systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), and heart rate variability (HRV). Consequently, there is interest in determining the impact of improving sleep on cardiovascular risk. We reviewed studies aimed at improving sleep using (1) Cognitive Behavioural Therapy for Insomnia (CBT-I) and/or sleep hygiene and (2) sleep extension on these risk factors. Methods Literature searches were performed on MEDLINE, EMBASE, CINAHL, and Cochrane Library. Studies featuring adults ≥ 18years, a sleep intervention and pre and postrisk factor measurements available were included. Studies of obstructive sleep apnoea were excluded. Results From 21 studies (n = 1222), meta-analyses of 12 RCTs (n = 688), demonstrated a significant reduction in SBP averaging 4.91 mmHg [2.38, 7.43, P < 0.00001, heterogeneity (I2) = 74%], compared to control. When 15 RCTs and non-RCTs were combined (n = 860), reductions in SBP and DBP averaged 5.02 mmHg (95% CI 2.80, 7.23, P < 0.00001, I2 67%) and 2.90 mmHg (0.30, 5.49; P = 0.03, I2 88%), respectively. In eight CBT-I and/or sleep hygiene interventions (n = 618), the SBP decrease averaged 3.44 mmHg (1.07, 5.80, P = 0.004). In sleep extension interventions (n = 242; 7 studies), reductions in SBP averaged 7.59 mmHg (4.74, 10.44; P < 0.00001), DBP 4.83 mmHg (0.73, 8.92; P = 0.02), and HR (n = 164, 4 studies) 1.24 beats/minute (0.44, 2.44; P = 0.04). No significant changes in HRV were observed. Seven studies were of low concern in the quality assessment. Conclusions Using behavioural sleep interventions led to clinically significant reductions in blood pressure, suggesting addressing poor sleep health could feature in blood pressure management. Future randomized controlled trials are still required. PROSPERO Identification number CRD42025628290