TY - JOUR
T1 - Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV
T2 - Data from the Veterans Aging Cohort Study
AU - Polanka, Brittanny M.
AU - Kundu, Suman
AU - So-Armah, Kaku A.
AU - Freiberg, Matthew S.
AU - Gupta, Samir K.
AU - Bedimo, Roger J.
AU - Budoff, Matthew J.
AU - Butt, Adeel A.
AU - Chang, Chung Chou H.
AU - Gottlieb, Stephen S.
AU - Marconi, Vincent C.
AU - Womack, Julie A.
AU - Stewart, Jesse C.
N1 - Funding Information:
S.K.G. reports funding from the National Institutes of Health, Indiana University, and Gilead Sciences; advisory board fees from Gilead Sciences and GlaxoSmithKline/ViiV; and travel support to present data at scientific conferences from Gilead Sciences and Bristol-Myers Squibb. M.J.B. reports funding from the National Institutes of Health and General Electric. A.A.B. reports funding from Gilead, and Merck. J.C.S. reports funding from the National Institutes of Health and Indiana University. 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.
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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 the Department of Veterans Affairs (VA) and Medicare administrative data and VA fee-for-service data. Those with baseline CVD were excluded.Results:HIV-infected (N = 3108) 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 [hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.16 to 2.31, P = 0.005], CVD risk factors (HR = 1.62, 95% CI: 1.14 to 2.30, P = 0.007), additional potential confounders (hepatitis C infection, renal disease, anemia, alcohol use, and cocaine use; HR = 1.70, 95% CI: 1.19 to 2.43, P = 0.003), and HIV-specific factors (HIV-1 RNA, CD4+ T-cell count, and antiretroviral therapy; HR = 1.66, 95% CI: 1.16 to 2.37, P = 0.005). Additional adjustment for nonbenzodiazepine sleep medication (HR = 1.62, 95% CI: 1.13 to 2.32, P = 0.009) did not attenuate the association; however, it fell short of significance at P < 0.01 after adjustment for depressive symptoms (HR = 1.51, 95% CI: 0.98 to 2.32, P = 0.060) or antidepressant medication (HR = 1.51, 95% CI: 1.04 to 2.19, P = 0.031).Conclusions: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.
AB - 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 the Department of Veterans Affairs (VA) and Medicare administrative data and VA fee-for-service data. Those with baseline CVD were excluded.Results:HIV-infected (N = 3108) 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 [hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.16 to 2.31, P = 0.005], CVD risk factors (HR = 1.62, 95% CI: 1.14 to 2.30, P = 0.007), additional potential confounders (hepatitis C infection, renal disease, anemia, alcohol use, and cocaine use; HR = 1.70, 95% CI: 1.19 to 2.43, P = 0.003), and HIV-specific factors (HIV-1 RNA, CD4+ T-cell count, and antiretroviral therapy; HR = 1.66, 95% CI: 1.16 to 2.37, P = 0.005). Additional adjustment for nonbenzodiazepine sleep medication (HR = 1.62, 95% CI: 1.13 to 2.32, P = 0.009) did not attenuate the association; however, it fell short of significance at P < 0.01 after adjustment for depressive symptoms (HR = 1.51, 95% CI: 0.98 to 2.32, P = 0.060) or antidepressant medication (HR = 1.51, 95% CI: 1.04 to 2.19, P = 0.031).Conclusions: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.
KW - HIV
KW - VACS
KW - cardiovascular disease
KW - insomnia
KW - prospective study
KW - sleep disturbance
KW - veterans
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U2 - 10.1097/QAI.0000000000001981
DO - 10.1097/QAI.0000000000001981
M3 - Article
C2 - 30768487
AN - SCOPUS:85064722223
SN - 1525-4135
VL - 81
SP - 110
EP - 117
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -