The Journal of American Heart Association recently published a research article that elucidates the potential association between insomnia and the occurrence of early-onset atrial fibrillation. The present investigation, under the leadership of Allison E. Gaffey, PhD, a clinical psychologist specializing in cardiovascular medicine, scrutinized electronic health records encompassing a sample size exceeding one million young veterans who were tracked over a period exceeding 15 years. The study revealed a positive correlation between insomnia, a prevalent form of persistent sleep disruption, and the likelihood of developing atrial fibrillation in patients.
Atrial fibrillation, a cardiovascular disorder, is distinguished by an irregular heart rhythm and is commonly observed in the elderly population. Individuals diagnosed with the aforementioned medical condition may present symptoms such as arrhythmias, cardiac palpitations, and episodes of dizziness. The management of atrial fibrillation may involve the administration of pharmacological agents, such as beta blockers, to regulate the heart rate, as well as anticoagulants to mitigate the heightened susceptibility to stroke.
According to Gaffey, it is common for chronic cardiovascular conditions such as atrial fibrillation to be diagnosed during the later stages of life. However, these conditions are believed to have their origins in earlier health behaviors and concerns.
In recent times, there has been a growing emphasis by prominent medical institutions such as the American Heart Association on comprehending the impact of sleep on cardiovascular well-being. Sleep disruptions are prevalent among both male and female veterans as well as the general population. Gaining insight into the potential associations between these conditions and atrial fibrillation could lead to earlier prospects for prevention and diagnosis.
Gaffey stated that there has been an increasing focus on the impact of sleep disturbances and disorders on the susceptibility to cardiac and vascular diseases. This investigation was initiated with the intention of gaining a deeper comprehension of the impact of sleep on subsequent health conditions.
Prior studies have established a correlation between atrial fibrillation and the likelihood of developing obstructive sleep apnea, a prevalent condition characterized by breathing difficulties during sleep. This disorder is particularly prevalent among overweight and obese adults. Nevertheless, prior to this study, there was limited knowledge regarding the significance of insomnia in relation to its role as a risk factor for atrial fibrillation.
In addressing this inquiry, the investigators utilized data sourced from the Manpower Data Center of the U.S. Department of Defense. Specifically, they accessed information pertaining to 1,177,204 individuals who underwent medical treatment at Veterans Affairs (VA) medical centers during the period spanning from October 1, 2001 to December 31, 2017. The extensive dataset encompassed various healthcare utilization factors, such as hospitalizations, outpatient visits, pharmacy prescriptions, and other relevant variables. In addition to insomnia and atrial fibrillation, the dataset contained information regarding other medical diagnoses of the patients, as well as demographic characteristics including age, gender, and race.
The findings of the study demonstrated a notable correlation between insomnia and the risk of atrial fibrillation. Specifically, patients diagnosed with insomnia exhibited a 32% higher likelihood of developing atrial fibrillation compared to individuals without a diagnosis of insomnia. In order to ascertain the specific influence of insomnia on the observed effect, the researchers made appropriate adjustments to their analysis to account for potential confounding variables, such as obstructive sleep apnea. Even after controlling for potential confounding factors, the researchers observed a significant association between severe sleep disturbances and an elevated risk of developing atrial fibrillation, indicating an independent relationship between the two variables.
“We sought to investigate whether the initial impact of insomnia would persist after controlling for other variables that are recognized to not only contribute to the presence of insomnia, but also increase the susceptibility to cardiovascular conditions like atrial fibrillation,” stated Gaffey. We controlled for demographic variables, lifestyle factors (e.g., alcohol or substance use history), and other clinical conditions, such as prior diagnosis of sleep apnea or psychiatric disorders (e.g., depression, anxiety, or PTSD).
Despite the robust correlation observed between insomnia and atrial fibrillation in the study, it is important to acknowledge the presence of certain constraints within the research. Significantly, the researchers utilized data obtained from a cohort of younger individuals, with an average age of 28 years across the entire patient population. Furthermore, it is noteworthy that only a minority, comprising 14% of the patients, were female. Consequently, the implications of the study’s findings may not be universally applicable to the broader population, extending beyond younger individuals and specifically males. Furthermore, the authors have determined insomnia diagnoses by utilizing the VA electronic health record. However, it is important to acknowledge that patients may be subject to underdiagnosis of insomnia both within the VA system and in other healthcare environments.
The study possesses noteworthy practical implications for both healthcare providers and patients. The study emphasizes the significance of early identification of sleep disruptions due to their potential enduring effects. The authors highlight sleep as a modifiable risk factor and emphasize its potential significance in the prevention of atrial fibrillation. Furthermore, it is suggested that future investigations should explore the potential impact of insomnia treatment, such as the use of medication or cognitive behavioral therapy, on the likelihood of developing atrial fibrillation.
The present investigation pertaining to younger adults demonstrates an independent association between a prior occurrence of insomnia and an elevated susceptibility to the development of atrial fibrillation. In this scholarly endeavor, the authors make a valuable contribution to the expanding body of knowledge regarding the correlation between sleep health and heart health. Their findings hold promise for enhancing the quality of clinical treatment for young individuals who experience sleep disruptions.
