Insomnia and early incident atrial fibrillation: A 16-year cohort study of younger men and women Veterans

Abstract

AbstractBackgroundThere is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea (OSA) confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. The objectives of this investigation were first to determine the association of insomnia and early incident AF risk and second, to determine if AF onset is earlier among those with insomnia.MethodsThis retrospective analysis used electronic health records from a cohort study of U.S. Veterans who were discharged from military service as of October 1, 2001 (i.e., post-9/11) and received Veterans Health Administration (VA) healthcare, 2001-2017. 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 OSA, psychiatric disorders, and healthcare utilization.ResultsOverall, 1,063,723 post-9/11 Veterans (Mage=28.2 years, 12% 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 two years earlier. Insomnia-AF associations were similar after accounting for healthcare utilization, excluding Veterans with OSA, and among those with a sleep study (adjusted hazard ratios [aHR]: 1.29-1.34).ConclusionsIn younger adults, insomnia was independently associated with incident AF even when accounting for OSA. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.Clinical Perspective1.What is new?In more than one million younger men and women Veterans with 16 years of follow-up, a history of insomnia conferred a 32% increase in risk for atrial fibrillation (AF).The insomnia-AF association persisted despite accounting for obstructive sleep apnea, a well-known risk factor for AF, and other demographic, lifestyle, and clinical factors.Veterans with insomnia may also present with AF up to 2 years earlier compared to those without insomnia.2.What are the clinical implications?Insomnia is a potentially modifiable risk factor for AF and sleep should be a focus for AF prevention.Screening and referral for insomnia and other sleep symptoms is critical, particularly among patients with an elevated risk for cardiovascular disease, as observed in the Veteran population.Although sex-specific associations could not be examined, insomnia is more prevalent among women, and it is possible that insomnia-AF associations may differ by sex.