Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort

Abstract

Study objectives: Insomnia disorders as well as cardiometabolic disorders are highly prevalent in the psychiatric population compared to the general population. We aimed to investigate their association and evolution over time in a Swiss psychiatric cohort.

Methods: Data for 2861 patients (8954 observations) were obtained from two prospective cohorts (PsyMetab and PsyClin) with metabolic parameters monitored routinely during psychotropic treatment. Insomnia disorders were based on the presence of ICD-10 "F51.0" diagnosis (non-organic insomnia), the prescription of sedatives before bedtime or the discharge letter. Metabolic syndrome was defined using the International Diabetes Federation definition, while the 10-year risk of cardiovascular event or death was assessed using the Framingham Risk Score and the Systematic Coronary Risk Estimation, respectively.

Results: Insomnia disorders were observed in 30% of the cohort, who were older, predominantly female, used more psychotropic drugs carrying risk of high weight gain (olanzapine, clozapine, valproate) and were more prone to suffer from schizoaffective or bipolar disorders. Multivariate analyses showed that patients with high body mass index (OR = 2.02, 95%CI [1.51-2.72] for each ten-kg/m² increase), central obesity (OR = 2.20, [1.63-2.96]), hypertension (OR = 1.86, [1.23-2.81]), hyperglycemia (OR = 3.70, [2.16-6.33]), high density lipoprotein hypocholesterolemia in women (OR = 1.51, [1.17-1.95]), metabolic syndrome (OR = 1.84, [1.16-2.92]) and higher 10-year risk of death from cardiovascular diseases (OR = 1.34, [1.17-1.53]) were more likely to have insomnia disorders. Time and insomnia disorders were associated with a deterioration of cardiometabolic parameters.

Conclusions: Insomnia disorders are significantly associated with metabolic worsening and risk of death from cardiovascular diseases in psychiatric patients.

Keywords: Cardiovascular diseases; Insomnia disorders; Metabolic syndrome; Metabolic worsening; Psychiatry.

Fig. 1

^aDefined using the International Diabetes Fedearation definition; ^bBMI by 10kg.m-². ^cEstimated risk of death from cardiovascular disease within 10 years using the Systematic Coronary Risk Estimation. Models were adjusted for age, sex, smoking status, and pyschotropic medication (classified by the risk of weight gain), except the model for CVD was adjusted only for pyschotropic medication. ¹Models fitted with random effect at observation level. ²Models fitted with random effect at patient level. ***:p-value < 0.001; **:p-value ≤ 0.01. Correction for multiple testing was applied using false discovery rate. Abbreviations: BMI body mas index, CVD cardiovascular diseases, HDL high-density lipoprotein, MetS metabolic syndrome, N number

Fig. 2

Model for FPG was adjusted for time,age, sex, smoking status and pyschotropic medication. Model for TG was adjusted for time, age, interaction betwwen age and imsonia disorders, sex, smoikng status, setting of care (in/outpatient) and pyschotropic medication. Model for HDL-C was adjusted for time, age, interaction between age and imsonia disorders, smoking status and pyschotropic medication. Model for LDL-C was adjusted for time, age, interaction between age and imsonia disorders, sex and smoking status. Model for Total-C was adjusted for time, age, sex, interaction between age and imsonia disorders, sex, smoking status and pyschotropic medication. Models for 10-year CVD risks (FRS and SCORE) were adjusted for time and pyschotropic medication. ***:p-value < 0.001; **p-value < 0.01; *:p-value ≤ 0.05. Correction for multiple was applied using false discovery rate. Abbreviations: FPG fasting plasma glucose, FRS Framingham Risk Score, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, N number, SCORE  Systematic Coronary Risk Estimation, Total-C total cholesterol, TG triglycerides

Fig. 3

Models for BMI and waist circumference were adjusted for time, age, interaction between age and sleep disorders, sex, smoking status, and psychotropic medication. Model for diastolic blood pressure was adjusted for time, age, interaction between age and sleep disorders, sex and psychotropic medication. ***:p-value < 0.001; **:p-value < 0.01;*:p-value ≤ 0.05. Correction for multiple testing was applied using false discovery rate. Abbreviations: BMI body mas index, N  number