Data indicate that cardiovascular disease (CVD) is now among the leading causes of death among HIV-positive adults. “This increased CVD risk is not accounted for by traditional CVD or HIV-specific factors implicated in development of CVD,” says Brittanny Polanka, MS. “General population research supports a consistent link between sleep disturbance and increased CVD risk. Given that roughly 58% of the HIV-positive population experiences some form of disturbed sleep, it’s important to determine whether insomnia is a potential target for CVD prevention in the HIV population.”
For a study published in JAIDS, Polanka, Jesse Stewart, PhD, Samir Gupta, MD, Matthew Freiberg, MD, MSc, and colleagues sought to determine whether insomnia symptoms are independently associated with new-onset CVD in patients with HIV. Among HIV-positive and seronegative participants, in the Veterans Aging Cohort Study (VACS) Survey Cohort, insomnia symptoms were measured by a question asking how bothered individuals were with, “difficulty falling or staying asleep” over the past 4 weeks, and new-onset CVD was determined by ICD-9-CM codes for acute myocardial infarction or stroke and CPT codes for coronary artery revascularization procedures.
“Roughly 60% of our sample endorsed experiencing difficulty falling or staying asleep, with 50% indicating some level of bother with these symptoms,” explains Polanka. “HIV-positive veterans bothered a lot by difficulty falling or staying asleep exhibited a 62%-70% greater risk of incident CVD than those without these symptoms, independent of the CVD risk conferred by demographics, traditional CVD risk factors, other potential behavioral and medical confounders, and HIV-specific factors.”
Polanka hopes this line of research identifies insomnia as a new target, and insomnia treatment as a new approach, to CVD primary prevention among patients with HIV. “Overall, we hope to raise awareness regarding the role that psychosocial factors may play in HIV-CVD,” she adds. “We encourage physicians to screen HIV-positive patients for insomnia symptoms and to refer those patients who screen positive for further assessment and possible insomnia treatment.”
Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV