The Association Between Insomnia and Increased Future Cardiovascular Events: A Nationwide Population-Based Study : Psychosomatic Medicine

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The Association Between Insomnia and Increased Future Cardiovascular Events

A Nationwide Population-Based Study

Hsu, Chien-Yi MD; Chen, Yung-Tai MD; Chen, Mu-Hong MD; Huang, Chin-Chou MD; Chiang, Chia-Hung MD; Huang, Po-Hsun MD, PhD; Chen, Jaw-Wen MD; Chen, Tzeng-Ji MD, PhD; Lin, Shing-Jong MD, PhD; Leu, Hsin-Bang MD, PhD; Chan, Wan-Leong MD

Author Information

From the Division of Cardiology, Departments of Medicine (Hsu, C.-C. Huang, P.-H. Huang, J.-W. Chen, Lin, Leu, Chan), Medical Research and Education (C.-C. Huang, J.-W. Chen, Lin), Family Medicine (T.-J. Chen), and Psychiatry (M.-H. Chen), and Healthcare and Management Center (Leu, Chan), Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center (Hsu, Y.-T. Chen, C.-C. Huang, Chiang, P.-H. Huang, J.-W. Chen, Lin, Leu, Chan) and Institutes of Pharmacology (C.-C. Huang, J.-W. Chen), Clinical Medicine (Hsu, Chiang, P.-H. Huang, Lin, Leu), and Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (T.-J. Chen); Department of Medicine (Hsu), Taipei Veterans General Hospital Yuli Branch, Taipei, Taiwan; Department of Medicine (Y.-T. Chen), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; Taipei Medical University (Lin), Taipei, Taiwan.

Supplemental Content

Address correspondence and reprint requests to Wan-Leong Chan, MD, Healthcare and Management Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan. E-mail: [email protected]

Received for publication December 12, 2013; revision received February 1, 2015.

Psychosomatic Medicine 77(7):p 743-751, September 2015. | DOI: 10.1097/PSY.0000000000000199

Abstract

Objectives 

Insomnia may increase the risk of cardiovascular disease (CVD), but the reported magnitude of the associations between sleep characteristics and CVD is inconsistent. We investigated the association between insomnia and the risk of developing acute myocardial infarction (AMI) and/or stroke by using a nationwide, population-based cohort database in Taiwan.

Methods 

The analyses were conducted using information from a random sample of 1 million people enrolled in the nationally representative Taiwan National Health Insurance Research Database. A total of 44,080 individuals who were 20 years or older, including 22,040 people who had diagnosis of insomnia during the study period and an age-, sex-, comorbidity-matched group of 22,040 people without insomnia, were enrolled in our study. The study end points were the occurrence of cardiovascular events including AMI or stroke during follow-up.

Results 

During a 10-year follow-up, 302 AMI events and 1049 stroke events were identified. The insomnia group had a higher incidence of AMI (2.25 versus 1.08 per 1000 person-years) and stroke (8.01 versus 3.69 per 1000 person-years, p < .001). Cox proportional hazard regression model analysis showed that insomnia was independently associated with a higher risk of future AMI (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.31–2.16, p < .001), stroke (HR = 1.85, 95% CI = 1.62–2.12, p < .001), and the composite event index (HR = 1.81, 95% CI = 1.61–2.05, p < .001), after adjusting for age, sex, and comorbidities.

Conclusions 

Insomnia is associated with an increased risk of future cardiovascular events.

Copyright © 2015 by American Psychosomatic Society

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