Cardiovascular events in insomnia patients with post-traumatic stress disorder.
Cardiovascular events in insomnia patients with post-traumatic stress disorder.
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患有创伤后应激障碍的失眠患者的心血管事件。
DOI：
10.1016/j.sleep.2022.07.014
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发表时间：
2022
期刊：
影响因子：
4.8
通讯作者：
Attai,Parveen
中科院分区：
文献类型：
--
作者：
El-Solh,AliA;Lawson,Yolanda;Attai,Parveen
背景创伤后应激障碍(PTSD)和失眠都独立地与心血管死亡的更高风险相关。本研究的目的是确定在一大群退伍军人中，创伤后应激障碍合并失眠是否与重大心血管不良事件(MACEs)的风险高于任何一种情况。方法我们对2015年1月1日至2020年12月31日期间美国退伍军人健康管理局(VHA)的电子病历进行了回顾分析，该电子病历涵盖了18岁或以上的退伍军人，被诊断为创伤后应激障碍和失眠，或两者兼而有之。根据ICD-9和ICD-10的住院或门诊诊断代码，将MACE定义为新发心肌梗死(MI)、短暂性脑缺血发作(TIA)或中风。结果19,080名退伍军人，其中1840名PTSD合并失眠，17240名PTSD或失眠。基线平均年龄(SD)为46·3 (11·5)岁。在平均3.9(四分位数范围，2.4-5.1)年的随访中，206名退伍军人(1%)发生了事件MACE。在患有创伤后应激障碍和失眠的退伍军人中，MI、短暂性脑缺血发作和/或中风的累积发生率比仅有创伤后应激障碍和失眠的退伍军人更高(p=0.008)。在COX比例风险模型中，在调整了年龄、性别、吸烟、高血压、抑郁和合并症负担等多个协变量后，创伤后应激障碍合并失眠与发生急性脑梗塞的风险(危险比[HR]， 1.44；95%CI，1.38-1.50，p=0.01)显著相关。
BackgroundBoth post-traumatic stress disorder (PTSD) and insomnia are independently associated with a greater risk of cardiovascular mortality. The objective of this study is to determine whether PTSD plus insomnia is associated with a higher risk of major adverse cardiovascular events (MACEs) than either condition alone in a large cohort of veterans.MethodsWe conducted a retrospective analysis of the national Veterans Health Administration (VHA) electronic medical records covering veterans 18 years or older with the diagnosis of PTSD, insomnia, or both from January 1, 2015, to December 31, 2020. MACE was defined as new-onset myocardial infarction (MI), transient ischemic attack (TIA) or stroke, based onICD-9andICD-10diagnosis codes from inpatient or outpatient encounters.ResultsA total of 19,080 veterans, 1840 with PTSD plus insomnia and 17,240 with either PTSD or insomnia, were included in the analysis. Baseline mean (SD) age was 46.3 (11.5) years. During median follow-up of 3.9 (interquartile range, 2.4–5.1) years, 206 (1%) veterans developed incident MACE. Cumulative incidence for MI, TIA and/or stroke was larger in veterans with PTSD plus insomnia compared to PTSD and insomnia alone (p=0.008). In a Cox proportional hazards model, PTSD plus insomnia was significantly associated with greater risk of developing MACEs (hazard ratio [HR], 1.44; 95% CI, 1.38–1.50, p=0.01) than either condition after adjusting for multiple covariates including age, gender, smoking, hypertension, depression, and burden of comorbidities.ConclusionsThis cohort study found that PTSD plus insomnia is a risk factor for MACEs of greater magnitude than PTSD- or insomnia-alone.