Insomnia and the Risk of Acute Myocardial Infarction A Population Study

Department of Public Health, Faculty of Medicine, Trondheim, Norway.
Circulation (Impact Factor: 14.43). 11/2011; 124(19):2073-81. DOI: 10.1161/CIRCULATIONAHA.111.025858
Source: PubMed


Few prospective studies have investigated insomnia in relation to risk for coronary heart disease. We assessed insomnia symptoms and risk of acute myocardial infarction (AMI) in a large, population-based study.
A total of 52 610 men and women were followed up for a first AMI, and 2368 incident AMIs occurred during 11.4 years of follow-up, either identified at hospitals or by the National Cause of Death Registry. In our analyses, we adjusted for age, sex, marital status, education, shift work, blood pressure, lipids, diabetes mellitus, body mass index, physical activity, smoking, and alcohol consumption. Difficulties initiating and maintaining sleep and having a feeling of nonrestorative sleep were associated with a moderate increase in AMI risk. The multiadjusted hazard ratios for AMI were 1.45 (95% confidence interval 1.18-1.80) for people with difficulties initiating sleep almost every night, 1.30 (1.01-1.68) for those with difficulties maintaining sleep almost every night, and 1.27 (1.03-1.57) for those with a feeling of nonrestorative sleep more than once a week compared with people who never experienced these sleep difficulties. When we combined the symptoms, a dose-dependent association was seen between the number of insomnia symptoms and AMI risk (P for trend 0.003). Alternative multivariable models and different sensitivity analyses suggest that the results were robust, especially concerning difficulties initiating sleep.
Insomnia is associated with a moderately increased risk for AMI.

Download full-text


Available from: Lars Erik Laugsand,
  • Source
    • "Given that insomnia is a major public health problem affecting millions of individuals with a prevalence rate up to 10% in its chronic form (National Institutes of Health (NIH), 2005), it is critical to determine the underlying causes and correlates of CV disease in insomnia. In spite of evidence from epidemiological studies linking insomnia and cardiovascular disease (Lanfranchi et al., 2009; Laugsand et al., 2011; Rosekind and Gregory, 2010; Spiegelhalder et al., 2010), few studies have investigated nighttime autonomic nervous system (ANS) functioning in primary insomniacs (PI). Vagal influence on the heart can be noninvasively assessed by time-domain HRV indices (Camm et al., 1996), like the square root of the mean squared difference of beat-to-beat intervals (RMSSD), the percentage of adjacent beat-to-beat intervals changing N50 ms (pNN50) and frequency-domain heart rate variability (HRV) absolute power in the range of 0.15–0.4 "
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated cardiac vagal and sympathetic activity in 13 young primary insomniacs (PI; 24.4 ± 1.6 years) and 14 good sleepers (GS; 23.3 ± 2.5 years) during nocturnal sleep. Pre-ejection period (PEP; inversely related to beta-adrenergic sympathetic activity), interval between consecutive R-waves (RR), and vagal-related indices of time- and frequency-domain heart rate variability were computed during pre-sleep wakefulness and undisturbed arousal-free sleep stages (N2, SWS, REM) as well as across the whole night irrespective of the presence of disruptive sleep events (e.g. sleep arousals/awakenings) and/or sleep stage transitions. Groups exhibited a similar vagal activity throughout each undisturbed sleep stage as well as considering the whole night, with a higher modulation during sleep compare to prior wakefulness. However, PEP was constantly shorter (higher sympathetic activity) during pre-sleep wakefulness and each sleep stage in PI compared to GS. Moreover, pre-sleep RR intervals were positive associated with sleep efficiency and negative associated with wake after sleep onset in PI. Altogether our findings indicated a dysfunctional sympathetic activity but a normal parasympathetic modulation before and during sleep in young adults with insomnia.
    International journal of psychophysiology: official journal of the International Organization of Psychophysiology 07/2014; 93(3):332-339. DOI:10.1016/j.ijpsycho.2014.06.014 · 2.88 Impact Factor
  • Source
    • "Furthermore, sleep disorders are commonly associated with other major medical problems [3]–[4] and therefore present more frequently in the primary health care population. Sleep disturbances, such as those caused by obstructive sleep apnea (OSA) and insomnia, are associated with increased likelihood of cardiovascular disease, diminished quality of life, and increased all-cause mortality risk, and are now considered one of the top 10 potentially modifiable cardiovascular disease risk factors [1], [5]–[8]. Early recognition and treatment of common sleep disorders could therefore help minimize significant health, social and fiscal consequences [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.
    PLoS ONE 06/2014; 9(6):e101003. DOI:10.1371/journal.pone.0101003 · 3.23 Impact Factor
    • "A recent article in the journal Circulation finds that insomnia is associated with a heightened probability of acute myocardial infarction (Laugsand et al. 2011). This is not an isolated finding: insomnia has been broadly indicated as a significant health problem (e.g., Bass and Turek 2005), exacting substantial socioeconomic tolls (Metlaine et al. 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Using the 2008 National Study of the Changing Workforce, we study how two forms of flextime correlate with family stress, workplace stress, and sleep difficulties. The first flextime measure is the ability to easily take time off for personal and family matters, which correlates with a statistically and economically significant reduction in workplace stress. Subsequently, we find that this same flexibility is associated with 6–10 % reduction in the likelihood of self-reported sleep difficulties for the full sample, and as high as an 11–25 % reduction in a subgroup analysis concerning unmarried females with children. The second flextime measure is the option of a compressed workweek, which also correlates with a statistically reduction in workplace stress, though the estimate is considerably smaller than for the first flexibility; a subsequent analysis finds no statistically significant relationship between this flexibility and sleep difficulties. Our findings suggest that the more flexible flexibility (i.e., more short-notice schedule flexibility) appears to be associated with larger reductions in the probability of being stressed, enough, in fact, to carry through to noticeable improvements in concomitant sleep difficulties. Thus, the first form of flextime may function, based on this observational analysis, as a tangible non-medical way to meet worker flextime desires and firm aspirations for increased safety and less absenteeism, all while potentially offering a positive public health externality. The size and significance of the flextime results prevail through bias assessments and sensitivity analyses.
    Empirical Economics 06/2014; 48(4). DOI:10.1007/s00181-014-0836-4 · 0.60 Impact Factor
Show more