Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Heart Failure
Prognostic Significance of Insomnia in Heart Failure
Yuki KannoAkiomi YoshihisaShunsuke WatanabeMai TakiguchiTetsuro YokokawaAkihiko SatoShunsuke MiuraTakeshi ShimizuYuichi NakamuraSatoshi AbeTakamasa SatoSatoshi SuzukiMasayoshi OikawaShu-ichi SaitohYasuchika Takeishi
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2016 Volume 80 Issue 7 Pages 1571-1577

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Abstract

Background:Insomnia is associated with incident heart failure (HF), but the clinical significance and impact of insomnia on HF remain unclear.Methods and Results:Consecutive 1,011 patients admitted for HF were divided into 2 groups according to the presence of insomnia: HF with insomnia (insomnia group, n=519) and HF without insomnia (non-insomnia group, n=492). We compared (1) cardiac event rates including cardiac death and worsening HF; and (2) underlying clinical background including laboratory data, echocardiographic data, and cardiopulmonary exercise test between the 2 groups. On Kaplan-Meier analysis, cardiac event rate was significantly higher in the insomnia group than in the non-insomnia group (39.1 vs. 23.4%, P<0.001). The insomnia group, as compared with the non-insomnia group, had (1) higher plasma renin activity (P=0.042), renin concentration (P=0.007), and aldosterone (P=0.047); (2) lower peak V̇O2(14.9 vs. 16.3 ml/kg/min, P=0.002) and higher V̇E/V̇CO2slope (36.0 vs. 33.5, P=0.001); and (3) similar B-type natriuretic peptide and left ventricular ejection fraction. Importantly, on multivariate Cox proportional hazard analysis after adjusting for potential confounding factors, insomnia was an independent predictor of cardiac events in HF patients (hazard ratio, 1.899; P<0.001).Conclusions:Insomnia is an independent predictor of cardiac events in HF patients. HF patients with insomnia have activated renin-angiotensin-aldosterone system and lower exercise capacity. (Circ J 2016; 80: 1571–1577)

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© 2016 THE JAPANESE CIRCULATION SOCIETY
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