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Neurology. 2019 Nov 6. pii: 10.1212/WNL.0000000000008581. doi: 10.1212/WNL.0000000000008581. [Epub ahead of print]

Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults: A 10-year cohort.

Author information

1
From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing.
2
From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing. lmlee@vip.163.com yucanqing@pku.edu.cn.

Abstract

OBJECTIVE:

To examine the associations of individual insomnia symptoms with risks of incident cardio-cerebral vascular diseases (CVD) and possible moderating factors among Chinese adults.

METHODS:

The China Kadoorie Biobank is a prospective cohort study that recruited participants from 10 areas across China. Data from 487,200 adults 30 to 79 years of age who were free of stroke, coronary heart disease, and cancer at baseline were analyzed. Three insomnia symptoms were assessed with self-reported difficulties in initiating or maintaining sleep, early morning awakening, and daytime dysfunction for at least 3 d/wk at baseline. Incidences of CVD were followed up through disease registries and national health insurance databases until 2016.

RESULTS:

During a median of 9.6 years of follow-up, 130,032 cases of CVD were documented. Cox regressions showed that 3 insomnia symptoms were associated with increased risk of total CVD, with respective adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.09 (95% CI 1.07-1.11), 1.07 (95% CI 1.05-1.09), and 1.13 (95% CI 1.09-1.18). Participants with individual symptoms also had higher risks of ischemic heart disease (IHD; HR 1.13, 1.09, and 1.17) and ischemic stroke but not hemorrhagic stroke. Participants with all 3 symptoms were at an 18%, 22%, or 10% higher risk of CVD, IHD, or ischemic stroke compared to nonsymptomatic adults. Associations between 3 symptoms and CVD incidence were consistently stronger in younger adults or those without baseline hypertension (p for interaction <0.05).

CONCLUSIONS:

Individual and coexisting insomnia symptoms are independent risk factors for CVD incidence, especially among young adults or adults who have not developed hypertension.

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