Insomnia, sleep deprivation linked to increased risk for MI
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NEW ORLEANS — Insomnia was associated with increased risk for MI, especially among older adults and women, according to a meta-analysis presented at the American College of Cardiology Scientific Session.
“There have been studies that show that sleep deprivation leads to elevated cortisol which in turn accelerates atherosclerosis, contributing to coronary artery disease and subsequent MI. This is a possible mechanism that explains why insomniacs are at a higher risk of MI,” Yomna E. Dean, a medical student at Alexandria University, Egypt, told Healio. “Insomnia is associated with a higher risk for heart attacks. The more sleep deprived an individual is, the higher the risk for MI. Excessive sleep could be equally and even more harmful than sleep deprivation. This applies to both genders and different age groups.”
For this meta-analysis, simultaneously published in Clinical Cardiology, Dean and colleagues, under the leadership of Hani Aiash, MD, PhD, associate professor of cardiovascular perfusion, medicine and neurology at SUNY Upstate Medical University, identified nine observational controlled studies with data on the incidence of MI among adults with insomnia. The study included more than 1.1 million participants, of whom 154,414 had insomnia and approximately 1 million did not and served as controls.
The primary outcome was the incidence of MI. Secondary outcomes included sleep duration, age, sex and comorbidities.
Dean reported that individuals with insomnia experienced greater risk for MI compared with those without insomnia (RR = 1.69; 95% CI, 1.41-2.02; P < .00001).
“This is a significant risk. However, we don’t find it in guidelines: the importance of sleep and how essential it is to screen insomniacs for other risk factors and subsequent MIs,” Dean said.
The highest risk for MI was observed among patients who slept 5 hours or fewer compared with those who slept 7 to 8 hours (RR = 1.56; 95% CI, 1.41-1.73; P < .00001); however, participants who slept 6 hours had lower risk for MI compared those who slept 9 hours or more per day (RR = 0.75; 95% CI, 0.68-0.83; P < .00001).
“This indicates that both excessive sleep and severe sleep deprivation are associated with a higher risk for heart attacks. Nevertheless, when we analyzed patients who slept 6 hours vs. those who slept 9, we detected a lower risk for MI in the former group, demonstrating that excessive sleep could be more harmful than sleep deprivation,” Dean told Healio. “It is important to educate patients about this, as some may assume that if sleep deprivation is harmful to the heart, then excessively long sleep durations could be beneficial. However, that isn’t true.”
Although risk was elevated among both younger and older patients with insomnia, risk for MI was greatest among those older than 65 years (RR = 2.06; 95% CI, 1.52-2.79; P < .00001).
Risk for MI was also elevated among both men and women with insomnia; however, risk was greater among women (RR = 2.24; 95% CI, 1.54-3.25; P < .00001) compared with men (RR = 2.03; 95% CI, 1.78-2.23; P < .00001).
“Studies have shown that there is an enhanced corticotropin release factor in females and that’s why females have a higher prevalence of anxiety, panic disorders and depression,” Dean told Healio. “This could potentially explain why female insomniacs have a higher incidence of MI. Notwithstanding, other studies have shown that cortisol levels are higher among men in response to stress. We believe that future studies are needed to explain this further.”
Initiating and maintaining sleep — a common complaint from patients with insomnia — was associated with risk for MI (RR = 1.13; 95% CI, 1.04-1.23; P = .003), whereas nonrestorative sleep and daytime dysfunction were not (RR = 1.06; 95% CI, 0.91-1.23; P = .46).
“We need to prioritize sleep in our lives to maintain a healthy heart as our results have shown that sleep deprivation is associated with a higher risk for heart attacks; the more sleep deprived, the higher the risk we face. This is crucial nowadays more than ever as many individuals consciously sleep less to save time. However, in doing so we are harming our CV health,” Dean told Healio. “Those who suffer from insomnia and can’t get enough sleep despite prioritizing proper sleep hygiene should seek medical advice and should be screened for risk factors for MI.”
Reference:
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Dean Y, et al. Abstract 917-10. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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