Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans.
Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans.
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DOI：
10.1161/jaha.123.030331
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发表时间：
2023-10-17
影响因子：
5.4
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中科院分区：
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人们越来越多地考虑到睡眠障碍和早期心血管风险障碍，包括心房颤动（AF）。阻塞性睡眠呼吸暂停会增加患房颤的风险，但与另一种常见的睡眠障碍失眠高度共病。我们首先试图确定失眠与早期发生房颤风险之间的关系，其次，确定失眠症患者是否更早发生房颤。这项回顾性分析使用了一项队列研究中的电子健康记录，该队列研究的对象是自2001年10月1日（即9/11后）退伍并在2001年至2017年期间接受退伍军人健康管理局护理的美国退伍军人。时变、多变量Cox比例风险模型用于检验失眠诊断对房颤发病率的独立贡献，同时对人口统计学、生活方式因素、临床合并症（包括阻塞性睡眠呼吸暂停和精神障碍）和医疗保健利用进行连续调整。总体而言，1 063 723名9/11后退伍军人（平均年龄28.2岁，14%为女性）平均随访10年。共有4168例房颤（0.42/1000人-年）。失眠症与房颤调整风险增加32%相关（95% CI, 1.21-1.43），患有失眠症的退伍军人房颤发病时间可早2年。排除患有阻塞性睡眠呼吸暂停的退伍军人（aHR, 1.38 [95% CI, 1.24-1.53]）和有睡眠研究的退伍军人（aHR, 1.26 [95% CI, 1.07-1.50]），在考虑医疗保健利用后，失眠与房颤的关联相似（校正风险比[aHR]， 1.27 [95% CI, 1.17-1.39]）。在年轻人中，失眠与房颤事件独立相关。进一步的研究应确定这种关联是否因性别而异，以及失眠的行为或药物治疗是否能减轻房颤风险。
There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post‐9/11) and received Veterans Health Administration care, 2001 to 2017. Time‐varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post‐9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person‐years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21–1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia‐AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17–1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24–1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07–1.50]). In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.