Insomnia symptoms and incident heart failure: a population-based cohort study

Abstract

Aims Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF. Methods and results Data were obtained from the Health and Retirement Study in the US for a population-representative sample of 12,761 middle-aged and older adults (age ≥ 50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discrete-time survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. At baseline, 38.4% of the respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 1,730 respondents developed incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08–1.38), two (HR=1.45; 95% CI: 1.21–1.72), three (HR=1.66; 95% CI: 1.37–2.02), or four (HR=1.80; 95% CI: 1.25–2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents that had trouble initiating sleep (HR=1.17; 95%CI: 1.01–1.36), maintaining sleep (HR=1.14; 95% CI: 1.01–1.28), early-morning awakening (HR=1.20; 95% CI: 1.02–1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06–1.46) had a higher hazard of incident HF than asymptomatic respondents. Conclusion Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence.

Considering Psychosocial Factors When Investigating Blood Pressure in Patients with Short Sleep Duration: A Propensity Score Matched Analysis

“…However, actigraphy or polysomnography is not practical in outpatient populations, but self-report is much more acceptable and convenient. On the other hand, some studies demonstrate that self-report approach could be more sensitive than device detecting approach [ 41 , 42 ].…”

Heart failure and cancer: From active exposure to passive adaption

“…Sleep loss could also result in harmful outcomes, including heart diseases, certain cancers, and all-cause mortality ( 18 – 22 ). According to the data from the health and retirement study in the United States, insomnia symptoms, both cumulatively and individually, are associated with incident HF ( 23 ). Sleep loss is also related to various kinds of cancer, such as neck and head cancer ( 24 ), prostate cancer ( 25 ), and malignant brain tumor ( 26 ).…”

Longitudinal associations between time‐varying insomnia symptoms and all‐cause health care services utilization among middle‐aged and older adults in the United States

“…The response options for each question include "most of the time," "sometimes," and "rarely or never." Following other sleep studies, 16,19,20,[63][64][65][66] the respondents were ascertained to have experienced the insomnia symptom when they answered "most of the time" in the first three questions and when they answered "rarely or never" in the last question. Thus, each insomnia symptom was operationalized through a binary variable, "yes vs. no," in the analyses.…”

“…7,12 Insomnia symptoms are associated with the onset of a range of chronic health conditions, including cardiometabolic risk factors such as diabetes and hypertension, increased risks of cardiovascular diseases, cerebrovascular diseases, and cardiovascular-related or allcause mortality. 1,[13][14][15][16][17][18][19][20] In addition, they are considered significant risk factors for mental health problems such as depression, anxiety, and other psychiatric disorders, as well as cognitive decline and dementia. 1,5,[21][22][23][24][25] Furthermore, insomnia symptoms are potential risk factors for other health conditions such as weakened immune system and substance abuse disorders involving alcohol, nicotine, opiates, cannabis, or other substances.…”

“…Insomnia symptoms are associated with the onset of a range of chronic health conditions, including cardiometabolic risk factors such as diabetes and hypertension, increased risks of cardiovascular diseases, cerebrovascular diseases, and cardiovascular‐related or all‐cause mortality 1,13–20 . In addition, they are considered significant risk factors for mental health problems such as depression, anxiety, and other psychiatric disorders, as well as cognitive decline and dementia 1,5,21–25 .…”