Association between insomnia symptoms and incident heart failure among middle-aged and older adults: A population-based cohort study

Background. Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue.
Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We
investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep,
difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF.

Methods. Data were obtained from the Health and Retirement Study in the US for a sample of 12,761 adults
(age ≥50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in
2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discretetime survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors
and to account for bias due to differential loss to follow-up.

Results. At baseline, 38.4% of the respondents reported at least one insomnia symptom. During follow-up,
1,730 respondents had incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08–
1.38), two (HR=1.45; 95% CI: 1.21–1.72), three (HR=1.66; 95% CI: 1.37–2.02), or four (HR=1.80; 95% CI:
1.25–2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents.
Respondents experiencing trouble initiating sleep (HR=1.17; 95%CI: 1.01–1.36), maintaining sleep
(HR=1.14; 95% CI: 1.01–1.28), early-morning awakening (HR=1.20; 95% CI: 1.02–1.43), or non-restorative
sleep (HR=1.25; 95% CI: 1.06–1.46) had a higher hazard of incident HF than asymptomatic respondents.

Conclusions. Insomnia symptoms, both cumulatively and individually, are associated with incident HF.
Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged
to reduce HF incidence.