Insomnia, a new Modifiable Risk Factor for Heart Failure?

Mathieu Berger; Geoffroy Solelhac; Frédéric Roche; Raphael Heinzer


Eur Heart J. 2021;42(40):4177-4179. 

In This Article

Insomnia, Cardiovascular Risk, and Heart Failure

Chronic insomnia is one of the most common sleep disorders, affecting ~10–15% of the population.[1] Furthermore, it is estimated that 30–40% of adults report symptoms of insomnia at some point in a given year.[2] Insomnia symptoms commonly wax and wane over time, and chronic insomnia disorder is diagnosed when these symptoms are present on at least three nights per week for at least 3 months despite adequate opportunity to sleep.

Growing evidence links insomnia disorder with several health-related impairments including reduced quality of life,[3] mental disorders,[4] hypertension,[5] and cardiovascular diseases.[6] Insomnia symptoms are also highly prevalent in patients with heart failure (HF).[7] However, few studies have investigated whether insomnia is prospectively associated with an increased incidence of HF among subjects free of HF at baseline.

In the largest epidemiological trial to date, Laugsand et al. collected baseline data on insomnia symptoms in 54 279 participants from the HUNT study, Norway.[8] Their results highlighted a dose-dependent association between the number of insomnia symptoms and the risk of newly diagnosed HF over 11 years of follow-up after full adjustment for the main cardiovascular risk factors. However, insomnia symptoms were measured only once at baseline; therefore, the potential effects of time-dependent changes in the severity of insomnia symptoms were not considered, which is important because previous studies suggested that insomnia symptoms can follow multiple trajectories over time.[9]

In this issue of the European Heart Journal, Mahmood et al. expand the current literature by investigating the longitudinal association between time-varying insomnia symptoms and incident HF in 12 761 middle- to older-aged adults from the Health and Retirement Study (HRS)–US.[10] Insomnia symptoms were defined as reporting most of the time difficulty initiating sleep, difficulty maintaining sleep, and early-morning awakening, and/or rarely or never reporting non-restorative sleep. Their results show that ~38% of participants reported having at least one insomnia symptom, which is consistent with the existing litterature.[2] The authors found that each insomnia symptom taken individually was associated with a higher risk of incident HF compared with not experiencing the symptom during the 16-year follow-up. Furthermore, they confirmed the dose-dependent relationship between the cumulative number of insomnia symptoms and incident HF, as previously described in the HUNT study.[8]