Brief Report: Insomnia and Risk of Myocardial Infarction Among People With HIV

Abstract

Background: Insomnia is common among people living with HIV (PLWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association of insomnia with MI risk by MI type among PLWH. Setting: Longitudinal, multisite cohort study of adult PLWH in care at five Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites in the US. Methods: Clinical data and patient-reported measures and outcomes (PROs) from PLWH in CNICS between 2005-2018 were utilized in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. CNICS centrally adjudicates MIs using expert reviewers, with distinction between type 1 (T1MI) and type 2 MIs (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, HIV viral suppression, CD4 count, traditional cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, poor kidney function, smoking), and stimulant use.Results: Among 12,436 PLWH, 48% reported insomnia. Over an average of 3.8 years of follow-up, 153 T1MIs and 105 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for demographic characteristics, CVD risk factors, and stimulant 4 use, the hazard ratios for T1MI and T2MI among PLWH reporting insomnia were 1.04 (95%CI:0.75-1.45) and 1.57 (95%CI:1.05-2.36), respectively.Conclusions: PLWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared to PLWH without insomnia, highlighting the importance of distinguishing MI types among PLWH.

Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data

“…Similar findings were reported by Mahmood et al who followed 15,511 patients with insomnia for fourteen years, and showed an increased risk of all-cause mortality in this cohort. While these studies parallel the findings of the recent meta-analysis, some newly published studies have undermined the magnitude of these results after adjusting for confounders and covariates [ 18 – 21 ]. A very recently published study by Lechat et al (2022) showed non-significant positive association between insomnia and coexisting obstructive sleep apnea with incidence of cardiovascular events (hazard ratio 1.38 with 95% CI [0.92–2.07]) after adjusting for pre-specified covariates [ 20 ].…”

“…After screening full texts for eligibility, 40 articles were excluded. As a result, 21 observational studies [ 18 , 20 , 21 , 30 – 47 ]. were selected for conducting our meta-analysis.…”

“…A very recently published study by Lechat et al (2022) showed non-significant positive association between insomnia and coexisting obstructive sleep apnea with incidence of cardiovascular events (hazard ratio 1.38 with 95% CI [0.92–2.07]) after adjusting for pre-specified covariates [ 20 ]. Similarly, another recent study examining the risk of myocardial infarction (MI) in HIV patients with insomnia showed no significant association between type 1 MI and insomnia but a reduced yet significant association with type 2 MI after adjusting for confounders [ 21 ]. Observational studies examining comparative clinical outcomes in patients with and without insomnia have yielded conflicting and inconsistent results, and thus meriting the conduction of an updated meta-analysis to adequately address these queries which can have major impact on cardiovascular outcomes.…”

Do sleep disturbances contribute to comorbidities in HIV?

“…In an analysis of clinical data from five US sites between 2005 and 2015 ( n = 12 448 PWH), those with bothersome insomnia symptoms had elevated risk of incident MI [23 ▪ ]. Insomnia was assessed with a single nonvalidated question and 48% reported mildly to severely bothersome insomnia symptoms.…”

Sleep Disturbance in the Context of HIV: A Concept Analysis

“…The concept of sleep disturbance has been used inconsistently in the HIV context. Although sleep disturbanc e was most used among the terms referring to similar concepts, several other concepts have been used interchangeably, including poor sleep ( Abdu & Dule, 2020 ; Alikhani et al, 2020 ; Cody et al, 2020 ), sleep complaint ( Faraut et al, 2021 ; González-Tomé et al, 2018 ), sleep difficulty ( Mahmood et al, 2018 ), sleep disruption ( Aouizerat et al, 2021 ; Hixon et al, 2020 ), sleep pattern problem ( Bedaso et al, 2020 ), sleep alteration ( Moore et al, 2020 ), sleep disorder ( Chen et al, 2021 ; Chenxi et al, 2019 ), and insomnia ( Buchanan et al, 2018 ; Cody et al, 2020 ; Luu et al, 2022 ; Pujasari et al, 2020 ). Many previous researchers have undertaken studies to examine sleep among PLWH; however, there is no consensus on an accurate definition of sleep disturbance.…”