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Insomnia symptoms associated with mortality

Insomnia symptoms, especially difficulty initiating sleep and non-restorative sleep, are associated with a higher risk of mortality, according to a study published recently in Circulation.1

23,447 men participating in the Health Professionals Follow-Up Study, who were free of cancer, which reported on insomnia symptoms in 2004, were followed-up to 2010. Deaths were identified from state vital statistic records, the National Death Index, family reports, and the postal system.

The authors, led by Dr Xiang Gao (Brigham and Women’s Hospital, Boston, USA) documented 2,025 deaths during six years of follow-up (2004–2010). The multivariable-adjusted hazard ratios of total mortality were 1.25 for difficulty initiating sleep, 1.09 for difficulty maintaining sleep, 1.04 for early-morning awakenings, and 1.24 for non-restorative sleep, comparing men with those symptoms most of the time with men without those symptoms, after adjusting for age, lifestyle factors, and presence of common chronic conditions.

Men with difficulty initiating sleep and non-restorative sleep most of the time had a 55% and 32% increased risk of cardiovascular disease mortality, respectively, relative to men without those symptoms.

Dr Xiang Gao (Brigham and Women’s Hospital, Boston, USA)

Dr Xiang Gao (Brigham and Women’s Hospital, Boston, USA)

Speaking to BJC Arrhythmia Watch, Dr Gao said: “In this large prospective study including over 23,000 US men, we found that difficulty initiating sleep and non-restorative sleep were associated with a higher risk of mortality during six years of follow-up. The associations were particularly strong for death due to cardiovascular disease.

He added: “In the subsequent meta-analysis, in which we summarised our study and nine other published studies on this topic, we found similar results…There were three published studies from Europe.”2,3,4

“Individuals with CVD should consulate with their physician about their sleep. I would recommend cognitive behavioural therapy for chronic sleep problems,” Dr Gao concluded.

References

1. Li Y, Zhang X, Winkelman JW, et al. Association between insomnia symptoms and mortality: a prospective study of US men. Circulation 2014;129:737–46. http://dx.doi.org/10.1161/​CIRCULATIONAHA.113.004500

2. Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med 2002;251:207–16.

3. Nilsson PM, Nilsson JA, Hedblad B, Berglund G. Sleep disturbance in association with elevated pulse rate for prediction of mortality – consequences of mental strain? J Intern Med 2001;250:521–9.

4. Rod NH, Vahtera J, Westerlund H, Kivimaki M, Zins M, Goldberg M, Lange T. Sleep disturbances and cause-specific mortality: results from the GAZEL cohort study. Am J Epidemiol 2011;173:300–9. http://dx.doi.org/10.1093/aje/kwq371

Published on: March 28, 2014

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