Effects of different exercise modalities on sleep quality in patients with hypertension: a systematic review and network meta-analysis

Abstract Objective Hypertension is a globally prevalent chronic cardiovascular disease, and its blood pressure levels are closely related to sleep quality. The aim of this study is to systematically evaluate the relative effectiveness and ranking of different exercise modalities on the sleep quality of patients with hypertension, providing evidence for clinical practice. Methods Randomized controlled trials published in full text through September 2025, examining the effects of different exercise modalities on sleep quality in patients with hypertension, were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Database, PubMed, Cochrane Library, Web of Science, and Scopus. Two researchers independently performed literature screening, data extraction, and quality assessment.Meta-analysis was conducted using RevMan 5.4 and Stata 18.0 software. GRADE was used to evaluate the evidence level of outcome indicators. Results A total of 13 studies involving 1,104 patients were included. Different exercise modalities significantly improved sleep quality scores( I² = 92%, SMD = -1.24, 95% CI -1.71 to -0.78, P < 0.00001)as well as subjective sleep quality scores on the PSQI scale ( I² = 93%, MD = -0.62, 95% CI -1.06 to -0.18, P = 0.006), sleep latency scores ( I² = 94%, MD = -0.46, 95% CI -0.80 to -0.12, P = 0.007), sleep duration score ( I² = 87%, MD = -0.46, 95% CI -0.70 to -0.21, P = 0.0002), sleep efficiency score ( I² = 94%, MD = -0.54, 95% CI -0.92 to -0.15, P = 0.006), daytime dysfunction score ( I² = 95%, MD = -0.51, 95% CI -0.91 to -0.10, P = 0.02), and sleep disturbance score ( I² = 96%, MD = -0.45, 95% CI -0.95 to 0.04, P = 0.07). The subgroup analysis did not identify any sources of heterogeneity. The cumulative probability ranking plot shows that the SUCRA rankings for the four exercise modalities are: Yoga and Om chanting (100%)、 Baduanjin (71.8%)、 Range of Motion Exercise (69.3%)、 Yoga (62%). The evaluation results of the GRADE evidence level indicate that the outcome indicators of the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Sleep Disorder Measurement Scale all have a very low evidence level. Conclusion Different exercise modalities can significantly improve sleep quality in patients with hypertension. The SUCRA ranking indicates that Yoga and Om chanting showed a slight comparative advantage. Due to the limited number of included studies, the certainty of the evidence is very low, and high heterogeneity may lead to unstable ranking results. More high-quality studies are needed in the future to validate this finding.