Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV:Data from the Veterans Aging Cohort Study

• Type of Material: Article
• Authors: Brittanny M. Polanka, Indiana University; Suman Kundu, Emory University; Kaku A. So-Armah, Boston University; Matthew S. Freiberg, Vanderbilt University; Samir K. Gupta, Indiana University; Roger J. Bedimo, VA North Texas Healthcare System; Matthew J. Budoff, Los Angeles Biomedical Research Institute; Adeel A. Butt, Weill Cornell Medical College; Chung-Chou H. Chang, University of Pittsburgh; Stephen S. Gottlieb, University of Maryland; Vincent Marconi, Emory University; Julie A. Womack, Yale University; Jesse C. Stewart, Indiana University
• Language: English
• Date: 2019-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001981
• Title of Journal or Parent Work: JAIDS: Journal of Acquired Immune Deficiency Syndrome
• Volume: 81
• Issue: 1
• Start Page: 110
• End Page: 117
• Grant/Funding Information: The Veterans Aging Cohort Study was funded by grant U10AA13566 from the National Institute on Alcohol Abuse and Alcoholism and Veterans Health Administration Public Health Strategic Health Core Group.; This analysis was funded in part by grant R01HL126557 from the National Institutes of Health.
• Keywords: veterans; cardiovascular disease; sleep disturbance; prospective study; HIV; insomnia; VACS
• Research Categories: Psychology, Cognitive; Health Sciences, Medicine and Surgery; Health Sciences, Immunology; Health Sciences, Health Care Management

Abstract

Background: Insomnia is associated with increased cardiovascular disease (CVD) risk in the general population and is highly prevalent in people with HIV. The CVD risk conferred by insomnia in the HIV population is unknown. Methods: Using the Veterans Aging Cohort Study-Survey Cohort, insomnia symptoms were measured and dummy coded with the item, “Difficulty falling or staying asleep?” (5-point scale from no difficulty to bothers a lot). Incident CVD event ICD-9 codes (acute myocardial infarction, stroke, or coronary artery revascularization) were identified with VA and Medicare administrative data and VA fee-for-service data. Those with baseline CVD were excluded. Results: HIV-infected (N=3,108) veterans had a median follow-up time of 10.8 years, during which 267 CVD events occurred. Compared to HIV-infected veterans with no difficulty falling or staying asleep, HIV-infected veterans bothered a lot by insomnia symptoms had an increased risk of incident CVD after adjusting for demographics (HR=1.64, 95%CI=1.16–2.31, p=.005), CVD risk factors (HR=1.62, 95%CI=1.14–2.30, p=.007), additional potential confounders (hepatitis C infection, renal disease, anemia, alcohol use, cocaine use; HR=1.70, 95%CI=1.19–2.43, p=.003), and HIV-specific factors (HIV-1 RNA, CD4+ T-cell count, ART; HR=1.66, 95%CI=1.16–2.37, p=.005). Additional adjustment for non-benzodiazepine sleep medication (HR=1.62, 95%CI=1.13–2.32, p=.009) did not attenuate the association; however, it fell short of significance at p < .01 after adjustment for depressive symptoms (HR=1.51, 95%CI=0.98–2.32, p=.060) or antidepressant medication (HR=1.51, 95%CI=1.04–2.19, p=.031). Conclusion: Highly bothersome insomnia symptoms were significantly associated with incident CVD in HIV-infected veterans, suggesting that insomnia may be a novel, modifiable risk factor for CVD in HIV.