Data indicate that cardiovascular disease (CVD) is now among the leading causes of death among HIV-positive adults. “This increased CVD risk is not accounted for by traditional CVD or HIV-specific factors implicated in development of CVD,” says Brittanny Polanka, MS. “General population research supports a consistent link between sleep disturbance and increased CVD risk. Given that roughly 58% of the HIV-positive population experiences some form of disturbed sleep, it’s important to determine whether insomnia is a potential target for CVD prevention in the HIV population.”

For a study published in JAIDS, Polanka, Jesse Stewart, PhD, Samir Gupta, MD, Matthew Freiberg, MD, MSc, and colleagues sought to determine whether insomnia symptoms are independently associated with new-onset CVD in patients with HIV. Among HIV-positive and seronegative participants, in the Veterans Aging Cohort Study (VACS) Survey Cohort, insomnia symptoms were measured by a question asking how bothered individuals were with, “difficulty falling or staying asleep” over the past 4 weeks, and new-onset CVD was determined by ICD-9-CM codes for acute myocardial infarction or stroke and CPT codes for coronary artery revascularization procedures.

“Roughly 60% of our sample endorsed experiencing difficulty falling or staying asleep, with 50% indicating some level of bother with these symptoms,” explains Polanka. “HIV-positive veterans bothered a lot by difficulty falling or staying asleep exhibited a 62%-70% greater risk of incident CVD than those without these symptoms, independent of the CVD risk conferred by demographics, traditional CVD risk factors, other potential behavioral and medical confounders, and HIV-specific factors.”

Polanka hopes this line of research identifies insomnia as a new target, and insomnia treatment as a new approach, to CVD primary prevention among patients with HIV. “Overall, we hope to raise awareness regarding the role that psychosocial factors may play in HIV-CVD,” she adds. “We encourage physicians to screen HIV-positive patients for insomnia symptoms and to refer those patients who screen positive for further assessment and possible insomnia treatment.”

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