Prevalence and influencing factors of insomnia in patients with coronary heart disease: a systematic review and meta-analysis

Background Sleep is a pivotal component of cardiovascular health. However, clinical efforts in coronary heart disease (CHD) disproportionately focus on sleep-disordered breathing, while insomnia, the most prevalent sleep disorder among adults, remains underdiagnosed and undertreated. Aims This meta-analysis systematically evaluates the prevalence of insomnia and its influencing factors in patients with CHD to inform clinical prevention and management strategies. Methods Ten databases were searched from inception to 7 September 2025. The prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) were extracted to evaluate the prevalence of insomnia and its influencing factors in patients with CHD. RevMan 5.4 and Stata 15.0 software was used for data processing. Subgroup analyses, meta-regression, and sensitivity analyses were performed. Results Nineteen studies involving 5928 patients with CHD were included. The overall pooled prevalence of insomnia was 51.8% (95% CI: 0.446–0.590, P < 0.001). Significant risk factors identified were female sex(OR = 2.00, 95% CI: 1.58–2.52, P < 0.001), anxiety (OR = 1.61, 95% CI: 1.36–1.91, P < 0.001), depression (OR = 2.15, 95% CI: 1.48–3.13, P < 0.001), CHD duration ≥3 years (OR = 1.73, 95% CI: 1.25–2.40, P = 0.001), diabetes (OR = 1.50, 95% CI: 1.45–1.56, P < 0.001), and gastritis (OR = 2.24, 95% CI: 1.62–3.11, P < 0.001). Conclusion insomnia has a substantial prevalence in patients with CHD. Clinicians should prioritize early identification and intervention targeting modifiable risk factors (anxiety, depression, diabetes, and gastritis), particularly in female patients and those with a CHD duration ≥3 years. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024617785.