Brief Report: Insomnia and Risk of Myocardial Infarction Among People With HIV

Abstract

Background: Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH.

Setting: Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites.

Methods: Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine).

Results: Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45).

Conclusions: PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.

Figure 1.

Association between insomnia and first incident myocardial infarction by myocardial infarction type among people with HIV. Abbreviations: CI, confidence interval; HR, hazard ratio; MI, myocardial infarction; T1MI, type 1 myocardial infarction; T2MI, type 2 myocardial infarction. Insomnia is defined as having difficulty falling or staying asleep with bothersome symptoms. ^a Cox model adjusted for age, sex, race/ethnicity. ^b Cox model adjusted for age, sex, race/ethnicity, and traditional CVD risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking). ^c Cox model adjusted for age, sex, race/ethnicity, traditional CVD risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), and HIV markers (ART, viral suppression (VL≤400), and CD4 cell count). ^d Cox model adjusted for age, sex, race/ethnicity, traditional CVD risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (ART, viral suppression (VL≤400), CD4 cellcount), and stimulant use (cocaine/crack and/or methamphetamines).