Sleep

Nightmares and cardiometabolic diseases in an adult population-based sample.

Liu K, Solelhac G, et al. • Journal of psychosomatic research • 2026

PubMed 42160805 DOI 10.1016/j.jpsychores.2026.112867

TL;DR

Frequent nightmares show a significant association with cardiometabolic diseases, although the underlying mechanisms are not fully explained by dysregulation of the hypothalamic-pituitary-adrenal axis or autonomic nervous system alone.

Key Findings

Results

The prevalence of frequent nightmares declined across the three follow-up periods of the CoLaus|PsyCoLaus study.

Prevalence of frequent nightmares was 11.7% in the first follow-up, 8.1% in the second follow-up, and 7.7% in the third follow-up.
Sample sizes were 4223, 2850, and 2009 participants in the first, second, and third follow-ups, respectively.
The study was conducted in Lausanne, Switzerland as part of the population-based CoLaus|PsyCoLaus cohort.

Results

Participants with frequent nightmares tended to have higher body mass index and higher prevalence of hypertension and diabetes compared to the no-nightmare group.

This pattern was observed consistently across all three follow-ups.
Both questionnaire-based and ecological momentary assessment (EMA) methods were used to assess nightmare frequency.
The association was observed after multivariable adjustment.

Results

Ecological momentary assessment data showed that frequent nightmares were significantly associated with hypertension in the second follow-up.

Multivariable-adjusted odds ratio for hypertension was 2.53 (95% CI: 1.32–4.85) in the second follow-up.
The association was attenuated and non-significant in the third follow-up, with an odds ratio of 1.78 (95% CI: 0.92–3.41).
EMA data confirmed the questionnaire-based findings regarding the association between frequent nightmares and cardiometabolic conditions.

Results

Participants with frequent nightmares had significantly lower pulse wave amplitude drops index (PWAD) on polysomnography, suggesting differences in autonomic nervous system activity.

Multivariable-adjusted mean ± SE for PWAD was 46.31 ± 1.34 in the frequent nightmares group versus 52.02 ± 0.49 in the no-nightmare group.
PWAD is a polysomnographic measure used as a marker of autonomic nervous system function.
The difference in PWAD was statistically significant after multivariable adjustment.

Results

Salivary cortisol levels did not differ significantly between the frequent nightmares group and the no-nightmare group.

Salivary cortisol was used as a biomarker of hypothalamic-pituitary-adrenal (HPA) axis activation and stress response.
The null finding for cortisol suggests that HPA axis dysregulation alone does not fully explain the association between nightmares and cardiometabolic disease.
This finding was combined with the PWAD results to conclude that neither the HPA axis nor the autonomic nervous system alone fully accounts for the observed associations.

Discussion

The mechanisms linking frequent nightmares to cardiometabolic diseases are not fully explained by dysregulation of the hypothalamic-pituitary-adrenal axis or autonomic nervous system alone.

Nightmares can trigger stress responses and lead to insufficient or poor-quality sleep, which are associated with cardiometabolic diseases and their risk factors.
Neither salivary cortisol (HPA axis marker) nor PWAD (autonomic marker) fully accounted for the cardiometabolic associations observed.
The authors conclude that the underlying mechanisms remain incompletely understood and warrant further investigation.

What This Means

This research suggests that people who frequently experience nightmares are more likely to have cardiometabolic conditions such as high blood pressure (hypertension), diabetes, and higher body mass index compared to people who do not have nightmares. This finding was consistent across three rounds of data collection from a large Swiss community study involving thousands of adults, and was confirmed using both standard questionnaires and a more detailed real-time assessment method called ecological momentary assessment. The study also investigated why nightmares might be linked to these health conditions by measuring stress hormones (cortisol in saliva) and a sleep-based marker of the body's automatic nervous system (pulse wave amplitude drops). People with frequent nightmares had lower pulse wave amplitude drops scores, suggesting some difference in how their nervous system functions during sleep. However, cortisol levels were no different between those with and without nightmares, indicating that stress hormone dysregulation alone does not explain the link. This research suggests that frequent nightmares may be a meaningful signal of cardiometabolic health risk in the general population, but the biological pathways connecting nightmares to conditions like hypertension and diabetes are not yet fully understood. Neither the body's stress hormone system nor the autonomic nervous system alone appears to account for the association, pointing to the need for further research into other possible mechanisms such as sleep disruption or psychological stress pathways.

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Citation

Liu K, Solelhac G, Marchi N, Heinzer R, Marques-Vidal P. (2026). Nightmares and cardiometabolic diseases in an adult population-based sample.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2026.112867

Key Findings

What This Means

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