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Meta-Analysis
. 2023 Apr;46(4):376-385.
doi: 10.1002/clc.23984. Epub 2023 Feb 25.

Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis

Yomna E Dean  1 , Mohamed A Shebl  2 , Samah S Rouzan  1 , Bdoor Ahmed A Bamousa  3 , Nesreen Elsayed Talat  1 , Sana Afreen Ansari  4 , Yousef Tanas  1 , Muaaz Aslam  5 , Sara Gebril  6 , Taher Sbitli  3 , Ramy Eweis  7 , Rameen Shahid  8 , Amr Salem  1 , Heba Ahmed Abdelaziz  9 , Jaffer Shah  10 , Walaa Hasan  11 , Diaa Hakim  12 , Hani Aiash  13
Affiliations
Meta-Analysis

Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis

Yomna E Dean et al. Clin Cardiol. 2023 Apr.

Abstract

Background: Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI.

Methods: PubMed, Scopus, and Web of Science were searched using terms; such as "Insomnia" and "MI." Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis.

Results: Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41-2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7-8 h of sleep (RR = 1.56, 95% CI = 1.41-1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04-1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91-1.23, p = .46). Analysis of age, follow-up duration, sex, and comorbidities showed a significant association in insomniacs.

Conclusion: Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Keywords: STEMI; insomnia; myocardial infarction; sleep disorders.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the study selection process. Characteristics of the included studies.
Figure 2
Figure 2
Forest plot of the comparison between insomnia and the incidence of MI. MI, myocardial infarction.
Figure 3
Figure 3
Forest plot of the comparison between sleep duration and the incidence of MI. MI, myocardial infarction.
Figure 4
Figure 4
Forest plot of insomnia and the incidence of MI comparison between ≤5 years versus >5 years follow‐up duration subgroups. MI, myocardial infarction.
See this image and copyright information in PMC

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