Insomnia predicts risk for recurrent CV events
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Insomnia was independently associated with increased risk for recurrent major adverse CV events during 4 years of follow-up, including CV death, even after accounting for symptoms of anxiety and depression, researchers reported.
The findings were presented at ESC Preventive Cardiology 2022, a scientific congress of the European Society of Cardiology.
“Sleep problems are linked to mental health issues, but our study found that insomnia was still significantly associated with heart events even after accounting for symptoms of anxiety and depression,” Lars Frojd, a medical student at the University of Oslo in Norway, said in an ESC press release. “The findings suggest that heart patients should be assessed for insomnia and offered appropriate management.”
In a prospective study, Frojd and colleagues analyzed data from 1,082 patients a mean 16 months after MI and/or a coronary revascularization procedure, collecting data on insomnia, coronary risk factors and comorbidity (mean age, 62 years; 21% women). Researchers assessed insomnia with the Bergen Insomnia Scale, based on sleep symptoms per week during the past 3 months. The primary composite endpoint was major adverse CV events, defined as CV death, MI hospitalization, revascularization, stroke or HF, obtained from hospital records on average 4.2 years after the baseline study.
Within the cohort, 90% underwent revascularization, 47% participated in cardiac rehabilitation, 97% were prescribed antiplatelet therapy and 93% were prescribed statins.
Researchers observed 364 major adverse CV events in 225 patients, including 39 CV deaths. Forty-five percent of patients reported insomnia at baseline and 24% used sleep medication the past week.
For insomnia, the RR for recurrent major adverse CV events was 1.62 (95% CI, 1.24-2.11; P < .001). In analyses adjusted for age, sex, coronary risk factors, CV comorbidity and for symptoms of anxiety and depression, the RR of insomnia on recurrent major adverse CV events remained significant at 1.41 (95% CI, 1.05-1.89; P = .023).
Insomnia accounted for 16% of the major adverse CV events in attributable risk fraction analyses, behind smoking (27%) and low physical activity (21%).
Obstructive sleep apnea, as assessed by the Berlin questionnaire, was not associated with recurrent major adverse CV events, according to researchers.
“Our study indicates that insomnia is common in heart disease patients and is linked with subsequent cardiovascular problems regardless of risk factors, coexisting health conditions and symptoms of mental health,” Frojd said in the release. “Further research is needed to examine whether insomnia treatments such as cognitive behavioral therapy and digital applications are effective in this patient group.”
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Frojd LA, et al. Rapid-fire abstracts session 1 -- secondary prevention and rehabilitation. Presented at: ESC Preventive Cardiology; April 7-9, 2022. (Virtual meeting).
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