Anemia and Sleep Disturbances: Mechanisms, Evidence and Clinical Implications - a Narrative Review
Abstract
Background: Anemia, particularly iron deficiency anemia (IDA), is the most common subtype, which affects over two billion individuals worldwide and is associated with various sleep disturbances in both observational and interventional studies. Although there is a growing attention towards this connection, its mechanisms, extent and treatability of have not been thoroughly investigated.
Objectives: This narrative review assesses the relationship between anemia, including iron deficiency anemia (IDA) and non-IDA subtypes, and various sleep-related outcomes, such as subjective sleep quality, objective sleep architecture, total sleep duration, sleep latency, sleep efficiency, restless legs syndrome (RLS), periodic limb movements (PLMs), insomnia and sleep-disordered breathing across different age groups and populations.
Methods: We performed searches in PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library from the foundation of these databases until February 2026, without any language constraints. Eligible study formats encompassed cross-sectional surveys, prospective cohorts, case-control studies, randomized controlled trials (RCTs) of iron therapy that reported sleep outcomes, as well as current systematic reviews and meta-analyses. The synthesis was predominantly narrative due to significant variation among studies regarding anemia definitions, sleep assessment methodologies and population characteristics.
Results: Iron deficiency anemia is consistently…
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