Sleep Deprivation, Endothelial Dysfunction and Hypertension: A Narrative Review

This narrative review aims to elucidate the effects of sleep deprivation (SD) on vascular endothelial cells and blood pressure, synthesize the mechanistic pathways involved, and propose potential intervention strategies, thereby positioning SD as a treatable target in hypertension management. A comprehensive literature search was conducted using databases including PubMed, Web of Science, Embase, and Medline for studies published up to October 2025. Evidence was systematically reviewed to examine SD-induced endothelial dysfunction and its role in blood pressure regulation. Both acute SD (including single-night total sleep < 7 hours, extended wakefulness up to ~36 hours, or ≤5 consecutive nights of restricted sleep) and chronic SD (persistent sleep restriction > 1 week) could induce measurable endothelial impairment and sustained blood pressure elevation. Key mechanistic pathways identified included: (1) vasomotor imbalance, (2) sympathetic nervous system hyperactivation with impaired baroreflex sensitivity, (3) systemic inflammation, (4) oxidative stress, (5) metabolic disturbances, and (6) circadian misalignment affecting vascular clock genes. SD is a significant, modifiable risk factor for endothelial dysfunction and hypertension. These findings highlight the therapeutic potential of endothelial-focused approaches and SD intervention in sleep-compromised populations. Future research should prioritize elucidating the underlying mechanisms and developing valid, cost-effective interventions.