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

Brittanny M. Polanka, Suman Kundu, Kaku A. So-Armah, Matthew S. Freiberg, Samir Gupta, Roger J. Bedimo, Matthew J. Budoff, Adeel A. Butt, Chung Chou H. Chang, Stephen S. Gottlieb, Vincent C. Marconi, Julie A. Womack, Jesse C. Stewart

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Pages (from-to)110-117
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume81
Issue number1
DOIs
StatePublished - May 1 2019

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Sleep Initiation and Maintenance Disorders
Veterans
Cohort Studies
Cardiovascular Diseases
HIV
Confidence Intervals
Accidental Falls
International Classification of Diseases
Fee-for-Service Plans
CD4 Lymphocyte Count
Hepatitis C
Medicare
Cocaine
Antidepressive Agents
Population
HIV-1
Anemia
Coronary Vessels
Sleep
Stroke

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV : Data From the Veterans Aging Cohort Study. / Polanka, Brittanny M.; Kundu, Suman; So-Armah, Kaku A.; Freiberg, Matthew S.; Gupta, Samir; Bedimo, Roger J.; Budoff, Matthew J.; Butt, Adeel A.; Chang, Chung Chou H.; Gottlieb, Stephen S.; Marconi, Vincent C.; Womack, Julie A.; Stewart, Jesse C.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 81, No. 1, 01.05.2019, p. 110-117.

Research output: Contribution to journalArticle

Polanka, BM, Kundu, S, So-Armah, KA, Freiberg, MS, Gupta, S, Bedimo, RJ, Budoff, MJ, Butt, AA, Chang, CCH, Gottlieb, SS, Marconi, VC, Womack, JA & Stewart, JC 2019, 'Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV: Data From the Veterans Aging Cohort Study', Journal of acquired immune deficiency syndromes (1999), vol. 81, no. 1, pp. 110-117. https://doi.org/10.1097/QAI.0000000000001981
Polanka, Brittanny M. ; Kundu, Suman ; So-Armah, Kaku A. ; Freiberg, Matthew S. ; Gupta, Samir ; Bedimo, Roger J. ; Budoff, Matthew J. ; Butt, Adeel A. ; Chang, Chung Chou H. ; Gottlieb, Stephen S. ; Marconi, Vincent C. ; Womack, Julie A. ; Stewart, Jesse C. / Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV : Data From the Veterans Aging Cohort Study. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 81, No. 1. pp. 110-117.
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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 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.",
author = "Polanka, {Brittanny M.} and Suman Kundu and So-Armah, {Kaku A.} and Freiberg, {Matthew S.} and Samir Gupta and Bedimo, {Roger J.} and Budoff, {Matthew J.} and Butt, {Adeel A.} and Chang, {Chung Chou H.} and Gottlieb, {Stephen S.} and Marconi, {Vincent C.} and Womack, {Julie A.} and Stewart, {Jesse C.}",
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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

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.

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.

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