Although research has developed an indepth understanding of risk factors of atrial fibrillation (AF) in older adults, little is known about risk factors of this cardiovascular condition in younger adults. Allison E. Gaffey, PhD, and colleagues developed a 16-year cohort study of younger men and women veterans to determine an association between insomnia and early incidence of AF risk. The study also sought to determine if AF onset is early among young adults with insomnia.
Dr. Gaffey discussed the findings of the study with Physician’s Weekly.
Why did you feel this issue needed exploration?
AF is the most common arrhythmia, but our understanding of risk factors among younger versus older adults is incomplete. Sleep problems are increasingly prevalent in the United States, especially sleep-related breathing disorders like obstructive sleep apnea (OSA) and insomnia, yet such disorders are significantly underdiagnosed. Research links sleep apnea to an increased risk for AF, but less is known about the potential cardiovascular consequences of insomnia. Examining the associated risk in a younger population provides the opportunity to consider first, the role of sleep in AF risk and second, how to improve earlier AF prevention.
What are the most important findings from your study?
Over 16 years of follow-up, veterans with a diagnosis of insomnia had a 32% higher risk for AF when compared with those without an insomnia diagnosis (Figure). On average, veterans with versus those without insomnia developed AF two years earlier (at 43 years versus 45 years). These associations were independent of a diagnosis of OSA and consistent when excluding patients with suspected OSA or those who had participated in a sleep study.
How should healthcare professionals incorporate these findings?
Since the American Heart Association added sleep to its Essential 8 cardiovascular lifestyle and risk factors, routinely assessing for sleep problems is recommended. There are excellent, brief screeners that assess sleep– including symptoms of insomnia–in the clinic. Physicians can use this information to refer patients to sleep medicine or behavioral health for more extensive objective evaluation and treatment.
What would you like future research in this field to focus on?
Given their distinct experiences during military service, veterans are more vulnerable to sleep problems than non-veterans. While insomnia is common in the general population at large, women also often show a higher prevalence of insomnia than men. Therefore, we need additional studies of insomnia and AF in younger, non-veteran samples, especially those with a similar proportion of men and women.
What else should healthcare professionals know about your research?
First, as patients are unaware of the connections between sleep and risk for AF, you cannot depend on them to mention their sleep problems. They may not think it is relevant to their visit or have accepted that poor sleep is a norm. Uniform screening for sleep and asking about patients’ sleep quality and quantity are critical. Second, insomnia often relates to life stress and other psychological concerns. Given the potential effects on sleep and cardiovascular risk, it is important to understand your patient’s psychosocial history including recent stressors, and to monitor maintenance of behavioral health care.
