The following is a summary of “Insomnia and Early Incident Atrial Fibrillation: A 16‐Year Cohort Study of Younger Men and Women Veterans,” published in the October 2023 issue of Cardiology by Gaffey et al.
The connection between sleep disturbances and cardiovascular risks, notably atrial fibrillation (AF), has gained increasing attention. While obstructive sleep apnea is recognized for its link to AF, it frequently coexists with another common sleep disorder, insomnia. Their study aimed to establish the association between insomnia and the risk of early-onset AF. Additionally, the researchers sought to investigate whether the onset of AF occurs sooner among individuals affected by insomnia.
Conducting a retrospective analysis, the investigators utilized electronic health records from a cohort study involving US veterans discharged from military service post-9/11 and who received care from the Veterans Health Administration between 2001 and 2017. Employing time-varying, multivariate Cox proportional hazard models, the study group evaluated the independent contribution of insomnia diagnosis to AF incidence, adjusting for various factors like demographics, lifestyle, clinical comorbidities (including obstructive sleep apnea and psychiatric disorders), and healthcare utilization. The study tracked 1,063,723 post-9/11 veterans (mean age=28.2 years, 14% women) over an average of 10 years, revealing 4168 cases of AF (0.42/1000 person‐years). Insomnia emerged as a significant factor associated with a 32% increased adjusted risk of AF (95% CI, 1.21–1.43). Additionally, veterans with insomnia showed an onset of AF up to 2 years earlier. These associations persisted despite adjustments for health care utilization, exclusion of individuals with obstructive sleep apnea, and among those who underwent a sleep study.
In conclusion, their study establishes an independent association between insomnia and incident AF among younger adults. Future investigations should focus on exploring potential sex-based differences in this association and evaluate whether behavioral or pharmacological treatments targeting insomnia might mitigate the risk of AF.
Source: ahajournals.org/doi/10.1161/JAHA.123.030331
