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. 2021 Oct 21;42(40):4169-4176.
doi: 10.1093/eurheartj/ehab500.

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

Asos Mahmood  1 , Meredith Ray  2 , Aram Dobalian  1 , Kenneth D Ward  3 , SangNam Ahn  1
Affiliations

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

Asos Mahmood et al. Eur Heart J. .

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.

Keywords: Heart failure; Insomnia symptoms; Marginal structural models; Risk factor; Sleep disturbance.

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Figures

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Graphical abstract
Figure 1
Figure 1
Inclusion and exclusion flowchart for the study participants. HRS, Health and Retirement Study.
See this image and copyright information in PMC

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