title: The Association Between Insomnia and Increased Future Cardiovascular Events: A Nationwide Population-Based Study.
abstract: OBJECTIVE
  Insomnia may increase the risk of cardiovascular disease (CVD), but the reported magnitude of the associations between sleep characteristics and CVD is inconsistent. We investigated the association between insomnia and the risk of developing acute myocardial infarction (AMI) and/or stroke by using a nationwide, population-based cohort database in Taiwan.
  
  
  METHODS
  The analyses were conducted using information from a random sample of 1 million people enrolled in the nationally representative Taiwan National Health Insurance Research Database. A total of 44,080 individuals who were 20 years or older, including 22,040 people who had diagnosis of insomnia during the study period and an age-, sex-, comorbidity-matched group of 22,040 people without insomnia, were enrolled in our study. The study end points were the occurrence of cardiovascular events including AMI or stroke during follow-up.
  
  
  RESULTS
  During a 10-year follow-up, 302 AMI events and 1049 stroke events were identified. The insomnia group had a higher incidence of AMI (2.25 versus 1.08 per 1000 person-years) and stroke (8.01 versus 3.69 per 1000 person-years, p < .001). Cox proportional hazard regression model analysis showed that insomnia was independently associated with a higher risk of future AMI (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.31-2.16, p < .001), stroke (HR = 1.85, 95% CI = 1.62-2.12, p < .001), and the composite event index (HR = 1.81, 95% CI = 1.61-2.05, p < .001), after adjusting for age, sex, and comorbidities.
  
  
  CONCLUSIONS
  Insomnia is associated with an increased risk of future cardiovascular events.
authors.affiliation: From the Division of Cardiology, Departments of Medicine (Hsu, C.-C. Huang, P.-H. Huang, J.-W. Chen, Lin, Leu, Chan), Medical Research and Education (C.-C. Huang, J.-W. Chen, Lin), Family Medicine (T.-J. Chen), and Psychiatry (M.-H. Chen), and Healthcare and Management Center (Leu, Chan), Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center (Hsu, Y.-T. Chen, C.-C. Huang, Chiang, P.-H. Huang, J.-W. Chen, Lin, Leu, Chan) and Institutes of Pharmacology (C.-C. Huang, J.-W. Chen), Clinical Medicine (Hsu, Chiang, P.-H. Huang, Lin, Leu), and Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (T.-J. Chen); Department of Medicine (Hsu), Taipei Veterans General Hospital Yuli Branch, Taipei, Taiwan; Department of Medicine (Y.-T. Chen), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; Taipei Medical University (Lin), Taipei, Taiwan.
authors.forename: Chien-Yi
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.forename: Chin-Chou
authors.initials: CC
authors.lastname: Huang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chiang
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.forename: Hsin-Bang
authors.initials: HB
authors.lastname: Leu
authors.forename: Wan-Leong
authors.initials: WL
authors.lastname: Chan
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D009313:National Health Programs / Q000706:statistics & numerical data; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology