Heart failure risk identified in people with insomnia

By Lucy Piper, Senior medwireNews Reporter

People with insomnia appear to be at increased risk for developing heart failure, findings from a large Norwegian cohort study show.

While there was no evidence that individual insomnia symptoms alone increased the risk for heart failure, accumulation of up to a maximum of three symptoms increased the risk more than threefold.

Lead researcher Lars Laugsand, from the Norwegian University of Science and Technology in Trondheim, said in a press statement: "We related heart failure risk to three major insomnia symptoms including trouble falling asleep, problems staying asleep, and not waking up feeling refreshed in the morning."

The study, published in the European Heart Journal, showed that patients suffering from all three symptoms were at considerably higher risk for heart failure than those with only one or two symptoms.

Laugsand et al acknowledge that their study was unable to establish a definitive causal link between insomnia and heart failure. But they note that if a causal relationship is found, treating insomnia using sleep hygiene strategies or psychological or pharmacological therapies could help in heart failure prevention.

Information on insomnia symptoms and cardiovascular risk factors was collected for 54,279 individuals aged 20-69 years. The prevalence of having difficulties initiating sleep almost every night, having difficulties maintaining sleep almost every night, and having non-restorative sleep more than once a week were 3.4%, 2.5%, and 8.1%, respectively.

Over an average follow-up period of 11.3 years, 1412 of the participants developed heart failure, identified either on hospital admission or through the National Cause of Death Registry.

After adjusting for cardiovascular risk factors and previous acute myocardial infarction, people with two insomnia symptoms were 1.35 times more likely than those with none to develop heart failure, while those with three insomnia symptoms were 4.53 times more likely.

When depression and anxiety were also taken into account, people with two insomnia symptoms had a 1.20- to 1.43-fold increased risk for heart failure, while those with three symptoms had a 3.83- to 5.25-fold increased risk.

The researchers say that "abnormalities in the autonomic nervous system and neuroendocrine system may represent a biologically plausible causal link between insomnia and HF [heart failure]."

They conclude: "Insomnia is a frequent, easily recognizable and potentially manageable condition. If our results are confirmed by others and causation is proved, evaluation of insomnia symptoms might have consequences for cardiovascular prevention."

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