Abstract 15883: Insomnia and Risk of Cardiovascular Disease

Abstract

Objective: Although accumulating evidence shows sleep disorders may increase the risk of cardiovascular disease, the association is not consistent. We investigated the association between insomnia and the risk of development of acute myocardial infarction (AMI) and/or ischemic stroke by using a nationwide, population-based cohort database in Taiwan.

Methods: Our analyses were conducted using information from a random sample of 2 million people enrolled in the nationally representative Taiwan National Health Insurance Research Database. Cases with depression, anxiety disorder, sleep apnea, seizure disorder, and substance abuse were excluded. Totally 43,180 subjects who were aged 45 years or more, including 10,871 subjects who had diagnosis of insomnia during the study period (exposure group) and an age, sex, comorbidity-matched 32,309 subjects without insomnia (non-exposure group) were identified. Study end points were defined for the occurrence of cardiovascular events including AMI or stroke during follow-up period.

Results: During an average follow-up period of 4 years (4.4±2.7 years), there are 424 AMI events (0.98%) and 3,307 stroke events (7.66%). By comparison, the exposure group to insomnia had a higher incidence of AMI (1.63% vs 0.76% , p=<0.001) and stroke (11.18% vs 6.47% , p=<0.001). Cox proportional hazard regression model analysis showed that insomnia was independently associated with more risk of developing future AMI (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.90-2.79, p <0.0001), stroke (HR, 1.99; 95% CI, 1.86-2.14, p <0.001), and composite events (HR, 2.04; 95% CI, 1.91-2.18, p <0.001) after adjusting for age, gender, and co-morbidities. Subsequent subgroup analyses further demonstrated that the association between insomnia and CVD existed independently with other established cardiovascular risk factors.

Conclusion: Insomnia was associated with an increased risk of future cardiovascular events.