The association of anxiety and insomnia on blood pressure parameters in pregnancy: a pilot study

The association between clinical insomnia and anxiety and the association between anxiety and blood pressure (BP) elevation during pregnancy are known, but the potential interaction between insomnia and anxiety on BP parameters is less well understood. We evaluated insomnia’s effect on the association between anxiety and blood pressure. This was a prospective pilot cohort of pregnant gestational age matched inpatients and outpatients at a single institution between 2021 and 2022. Standardized measures of sleep (insomnia severity index, ISI) and anxiety (state anxiety inventory score, SAI-S) were used to establish clinical insomnia (ISI ≥ 15) and anxiety (SAI-S ≥ 40). Baseline characteristics were compared between those with and without insomnia and anxiety, and Pearson correlations were conducted to establish which BP parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP)] were most strongly linked to anxiety. We then used generalized estimating equations (GEE) to assess the association between anxiety and insomnia (independent variables) and these BP parameters (dependent variables), accounting for age, body mass index, and antihypertensive medications as potential confounders. Among 60 patients, 11 (18.3%) had insomnia and 15 (25%) had anxiety. Baseline characteristics are listed in the Table. SAI-S score correlated with elevation of DBP (p=0.04, r=0.26) but not SBP or MAP. In multivariable GEE models, increased anxiety was significantly associated with both increased DBP (beta 6.08, p=0.005) and MAP (beta 6.16, p=0.005). This was not modified by presence of insomnia (p-interaction=0.60) (Figure). Pregnant patients with anxiety in this prospective cohort had MAPs 6.2 mm Hg and DBPs 6.1 mm Hg higher than people without anxiety, and there was no evidence of interaction between insomnia and anxiety on this. Given that small increases in MAP and DBP are known to increase cardiovascular risks, developing interventions to address anxiety may be important in blood pressure management during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)