TY - JOUR
T1 - Insomnia and Risk of Myocardial Infarction Among People With HIV
AU - Luu, Brandon R.
AU - Nance, Robin M.
AU - Delaney, Joseph A.C.
AU - Ruderman, Stephanie A.
AU - Heckbert, Susan R.
AU - Budoff, Matthew J.
AU - Mathews, William C.
AU - Moore, Richard D.
AU - Feinstein, Matthew J.
AU - Burkholder, Greer A.
AU - Mugavero, Michael J.
AU - Eron, Joseph J.
AU - Saag, Michael S.
AU - Kitahata, Mari M.
AU - Crane, Heidi M.
AU - Whitney, Bridget M.
N1 - Funding Information:
Supported by several grants from the National Institutes of Health (CNICS NIAID Grant R24 AI067039, CNICS MI supplement NIAID R24S AI067039, University of Washington Center for AIDS Research NIAID Grant P30 AI027757, Third Coast Center for AIDS Research NIAID Grant P30 AI117943, Johns Hopkins University Center for AIDS Research Administrative Core Grant P30 AI094189, NHLBI Grant R01 HL126538, NHLBI Grant K01 HL137557, NIA Grant R56 AG057262, and NIDA Grant U01 DA036935). The work was also supported by a grant from the American Heart Association (16FTF31200010).
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background:Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH.Setting:Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites.Methods:Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine).Results:Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45).Conclusions:PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.
AB - Background:Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH.Setting:Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites.Methods:Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine).Results:Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45).Conclusions:PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.
KW - HIV
KW - insomnia
KW - myocardial infarction
KW - type 1 myocardial infarction
KW - type 2 myocardial infarction
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U2 - 10.1097/QAI.0000000000002910
DO - 10.1097/QAI.0000000000002910
M3 - Article
C2 - 35001042
AN - SCOPUS:85128245760
SN - 1525-4135
VL - 90
SP - 50
EP - 55
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -
