title: The association between insomnia symptoms and risk of cardio-cerebral vascular events: A meta-analysis of prospective cohort studies.
abstract: Background Insomnia symptoms have been suggested to be associated with the risk of cardio-cerebral events. However, the results of previous studies have been inconsistent. Therefore, we conducted a meta-analysis to examine whether there were associations between cardio-cerebral vascular events and insomnia symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening or non-restorative sleep. Design A meta-analysis of prospective cohort studies. Methods PubMed, Web of science and the Cochrane Library were searched without language restriction. Prospective cohort studies of adults with at least a 2-year follow-up duration were included. Random effect models were used in order to pool the results for each insomnia symptom. Subgroup and sensitivity analyses were conducted in order to assess potential heterogeneity, and funnel plots and Egger's tests were used in order to assess publication bias. Results Fifteen studies (23 cohorts) were included. Positive associations were observed between difficulty initiating sleep, difficulty maintaining sleep and non-restorative sleep with risk of cardio-cerebral vascular events. The pooled relative risks and 95% confidence intervals were 1.27 (1.15-1.40), 1.11 (1.04-1.19) and 1.18 (1.05-1.33), respectively. However, less evidence existed to support the conclusions about the association between early-morning awakening and cardio-cerebral vascular events. Conclusion Our meta-analysis demonstrated that insomnia symptoms of difficulty initiating sleep, difficulty maintaining sleep and non-restorative sleep were associated with an increased risk of future cardio-cerebral vascular events.
authors.affiliation: 1 The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.|2 Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: He
authors.affiliation: 1 The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.|2 Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: 1 The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.|2 Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China.
authors.forename: Guangxiao
authors.initials: G
authors.lastname: Li
authors.affiliation: 1 The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.|2 Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China.
authors.forename: Huixu
authors.initials: H
authors.lastname: Dai
authors.affiliation: 1 The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.|2 Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China.
authors.forename: Jingpu
authors.initials: J
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors; D055815:Young Adult
keywords: Insomnia symptoms; cardio-cerebral vascular events; meta-analysis; prospective cohort studies