A cross-sectional study surveyed 111 adults with pulmonary hypertension (see table below for different forms), predominantly UK-based, White, and female, to examine sleep problems and their psychological/quality-of-life impact. The design and procedure of the study were developed in association with the UK Pulmonary Hypertension Association, PHA UK, and medical experts in pulmonary hypertension.
Key findings:
- 79.8% had poor sleep quality — more than double the general population rate (36%)
- 35% had insomnia, 33.6% had excessive daytime sleepiness — both notably higher than general population rates
- Average sleep duration was normal (~6.5 hrs), suggesting the problem is sleep quality (falling asleep, disturbances) rather than quantity
- Awareness gap: only 45.4% of poor sleepers self-rated their own sleep as “bad” — suggesting many patients don’t recognise the problem, reinforcing the need for routine screening
- 40% had clinical-level depression, 29% had clinical-level anxiety
- Depression, not anxiety, was the key driver: statistically, depression explained the link between sleep difficulties and lower quality of life; anxiety did not significantly mediate this relationship — even though some patients described anxiety (and associated rumination) as a personal cause of poor sleep
What’s driving the sleep problems? No single dominant cause emerged. Contributing factors mentioned by participants included:
- Breathing difficulties/dyspnoea (most commonly cited)
- Anxiety and rumination (linked to difficulty falling asleep)
- Other health conditions/comorbidities
- Disruption from a bed partner
Notably, this study didn’t examine pulmonary hypertension-specific medications, including diuretic timing, or conditions like restless leg syndrome — a separate study found restless leg syndrome symptoms in 30% of a pulmonary hypertension sample.
Conclusion
Sleep difficulties and depression are common and interconnected in pulmonary hypertension, and both should be routinely screened for — regardless of patient demographics. Since no single cause explains poor sleep, interventions likely need to be individually tailored. No pulmonary hypertension-specific sleep trials currently exist, and the authors call for further research, including objective sleep measurement and exploration of how treatments themselves affect sleep.
Read more at this link on the Wiley Online Library
Citation
Green JL, Costin V, Armstrong I, Thompson AR, Rawlings GH. How Do Sleep Difficulties Interact With Anxiety, Depression and Health-Related Quality of Life in Pulmonary Hypertension? Clin Respir J. 2026 Aug;20(8):e70220. doi: 10.1111/crj.70220. PMID: 42538807; PMCID: PMC13428227.
| Type of pulmonary hypertension | ||
| Idiopathic pulmonary arterial hypertension | 43 (38.7%) | |
| Genetic or hereditary causes of pulmonary arterial hypertension | 6 (5.4%) | |
| Pulmonary arterial hypertension caused by connective tissue disorder | 6 (5.4%) | |
| Pulmonary arterial hypertension but unsure which type | 4 (3.6%) | |
| Caused by heart problems (e.g., heart valve disease) (WHO Group2) | 12 (10.8%) | |
| Caused by lung problems (e.g., COPD) (WHO Group 3) | 6 (5.4%) | |
| Chronic thromboembolic pulmonary hypertension CTEPH (WHO Group 4) | 27 (24.3%) | |
| Another cause of pulmonary hypertension | 3 (2.7%) | |
| Unsure | 4 (3.6%) |