title: Prognostic Significance of Insomnia in Heart Failure.
abstract: BACKGROUND
  Insomnia is associated with incident heart failure (HF), but the clinical significance and impact of insomnia on HF remain unclear.
  
  
  RESULTS
  Consecutive 1,011 patients admitted for HF were divided into 2 groups according to the presence of insomnia: HF with insomnia (insomnia group, n=519) and HF without insomnia (non-insomnia group, n=492). We compared (1) cardiac event rates including cardiac death and worsening HF; and (2) underlying clinical background including laboratory data, echocardiographic data, and cardiopulmonary exercise test between the 2 groups. On Kaplan-Meier analysis, cardiac event rate was significantly higher in the insomnia group than in the non-insomnia group (39.1 vs. 23.4%, P<0.001). The insomnia group, as compared with the non-insomnia group, had (1) higher plasma renin activity (P=0.042), renin concentration (P=0.007), and aldosterone (P=0.047); (2) lower peak V̇O2(14.9 vs. 16.3 ml/kg/min, P=0.002) and higher V̇E/V̇CO2slope (36.0 vs. 33.5, P=0.001); and (3) similar B-type natriuretic peptide and left ventricular ejection fraction. Importantly, on multivariate Cox proportional hazard analysis after adjusting for potential confounding factors, insomnia was an independent predictor of cardiac events in HF patients (hazard ratio, 1.899; P<0.001).
  
  
  CONCLUSIONS
  Insomnia is an independent predictor of cardiac events in HF patients. HF patients with insomnia have activated renin-angiotensin-aldosterone system and lower exercise capacity. (Circ J 2016; 80: 1571-1577).
authors.affiliation: Department of Cardiology and Hematology, Fukushima Medical University.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kanno
authors.forename: Akiomi
authors.initials: A
authors.lastname: Yoshihisa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Watanabe
authors.forename: Mai
authors.initials: M
authors.lastname: Takiguchi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yokokawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sato
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Abe
authors.forename: Takamasa
authors.initials: T
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Oikawa
authors.forename: Shu-Ichi
authors.initials: S
authors.lastname: Saitoh
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012084:Renin-Angiotensin System; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate