Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans
Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the associatio...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030331 |
| _version_ | 1797301652253835264 |
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| author | Allison E. Gaffey Lindsey Rosman Rachel Lampert Henry K. Yaggi Sally G. Haskell Cynthia A. Brandt Alan D. Enriquez Anthony J. Mazzella Melissa Skanderson Matthew M. Burg |
| author_facet | Allison E. Gaffey Lindsey Rosman Rachel Lampert Henry K. Yaggi Sally G. Haskell Cynthia A. Brandt Alan D. Enriquez Anthony J. Mazzella Melissa Skanderson Matthew M. Burg |
| author_sort | Allison E. Gaffey |
| collection | DOAJ |
| description | Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post‐9/11) and received Veterans Health Administration care, 2001 to 2017. Time‐varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post‐9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person‐years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21–1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia‐AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17–1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24–1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07–1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk. |
| first_indexed | 2024-03-07T23:25:36Z |
| format | Article |
| id | doaj.art-539c25b0008741b0aec988a194a7133e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:25:36Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-539c25b0008741b0aec988a194a7133e2024-02-21T04:31:11ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-10-01122010.1161/JAHA.123.030331Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women VeteransAllison E. Gaffey0Lindsey Rosman1Rachel Lampert2Henry K. Yaggi3Sally G. Haskell4Cynthia A. Brandt5Alan D. Enriquez6Anthony J. Mazzella7Melissa Skanderson8Matthew M. Burg9VA Connecticut Healthcare System West Haven CT USADivision of Cardiology, Department of Medicine University of North Carolina, Chapel Hill Chapel Hill NC USADepartment of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT USAVA Connecticut Healthcare System West Haven CT USAVA Connecticut Healthcare System West Haven CT USAVA Connecticut Healthcare System West Haven CT USAVA Connecticut Healthcare System West Haven CT USADivision of Cardiology, Department of Medicine University of North Carolina, Chapel Hill Chapel Hill NC USAVA Connecticut Healthcare System West Haven CT USAVA Connecticut Healthcare System West Haven CT USABackground There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post‐9/11) and received Veterans Health Administration care, 2001 to 2017. Time‐varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post‐9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person‐years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21–1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia‐AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17–1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24–1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07–1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.https://www.ahajournals.org/doi/10.1161/JAHA.123.030331atrial fibrillationinsomniarisk factorssleepveteransyoung adults |
| spellingShingle | Allison E. Gaffey Lindsey Rosman Rachel Lampert Henry K. Yaggi Sally G. Haskell Cynthia A. Brandt Alan D. Enriquez Anthony J. Mazzella Melissa Skanderson Matthew M. Burg Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation insomnia risk factors sleep veterans young adults |
| title | Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans |
| title_full | Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans |
| title_fullStr | Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans |
| title_full_unstemmed | Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans |
| title_short | Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans |
| title_sort | insomnia and early incident atrial fibrillation a 16 year cohort study of younger men and women veterans |
| topic | atrial fibrillation insomnia risk factors sleep veterans young adults |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030331 |
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