Difficulty in initiating sleep is associated with poor morning cardiovascular function

Hsin Jung Tsai, Terry B.J. Kuo, Albert C. Yang, Shih Jen Tsai, Cheryl C.H. Yang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Insomnia is a risk factor for hypertension and cardiovascular events, and this association is strongest for sleep-onset insomnia. This study explored morning cardiovascular function in individuals with sleep-onset insomnia by analysing heart rate variability (HRV), blood pressure variability, and baroreflex sensitivity. Sleep quality of fifteen good sleepers and 13 individuals with sleep-onset insomnia was measured by overnight polysomnography, followed by continuous recordings of the participant's blood pressure and heart rate for 10 min immediately after they had woken up the following morning. After morning awakening (averaged time: 12.33 ± 10.48 min), a significantly reduced vagal tone assessed by HRV, including lower total power of HRV, lower high frequency of HRV, and elevated slopes of systolic as well as diastolic blood pressure in the morning with a blunted baroreflex sensitivity in the insomnia group were noted, compared to the control group. No differences in sympathetic-related activity were observed. The regulation of cardiovascular activity by the parasympathetic nervous system plays an important role in sleep-onset insomnia. Weak vagal modulation and blunted baroreflex sensitivity were evident in this insomnia subtype, which indicates that difficulty in initiating sleep can independently affect morning cardiovascular function.

Original languageEnglish
Article number113518
JournalPsychiatry Research
StatePublished - Jan 2021


  • Blood pressure variability
  • Heart rate variability
  • Morning cardiovascular regulation
  • Sleep-onset insomnia


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