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Insomnia and Cardiovascular Health: Exploring the Link Between Sleep Disorders and Cardiac Arrhythmias

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Cardiovascular diseases (CVDs), driven by modern lifestyles, have increased, with atrial fibrillation (AF) being a major concern linked to heart failure and stroke. Insomnia affects a large population, especially younger individuals, males, and menopausal women, decreasing the quality of life and potentially causing autonomic disturbances and cardiac arrhythmias.

Purpose of Review

This review explores the link between insomnia and cardiac arrhythmias, particularly AF, and its impact on cardiovascular health and emphasizes the need to address insomnia in individuals with cardiac arrhythmias by tailored strategies for sleep management to improve their overall well-being.

Recent Findings

Recent findings emphasize maintaining a regular sleep schedule to lower AF and bradyarrhythmia risks. Better sleep scores correlate with reduced AF and bradyarrhythmia risks, while insomnia increases AF risk, particularly in those under 40 years of age. Studies underscore the potential impact of sleep management in reducing cardiovascular risks and highlight the importance of addressing sleep issues to improve cardiovascular health outcomes.

Summary

Our review presents compelling evidence connecting insomnia and AF. Improving sleep patterns and addressing sleep issues can reduce AF risk, benefiting cardiovascular health. A comprehensive approach for managing at-risk individuals with cardiac arrhythmias, considering co-existing conditions, can decrease long-term disease burden and expenses. Incorporating sleep assessments and interventions into cardiovascular risk management, especially for those with insomnia, is recommended. Further research is needed to fully comprehend the complex relationship between insomnia and cardiac arrhythmias.

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References

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. Drake CL, Pillai V, Roth T. Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia. Sleep. 2014;37(8):1295–304. https://doi.org/10.5665/sleep.3916. PMID: 25083009; PMCID: PMC4096198.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Drake CL, Cheng P, Almeida DM, Roth T. Familial risk for insomnia is associated with abnormal cortisol response to stress. Sleep. 2017;40(10):zsx143. https://doi.org/10.1093/sleep/zsx143. PMID: 28958055; PMCID: PMC5806584.

  3. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94. https://doi.org/10.1378/chest.14-0970.

    Article  PubMed  Google Scholar 

  4. Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016;5(4):780–4. https://doi.org/10.4103/2249-4863.201153.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rosenberg R, Citrome L, Drake CL. Advances in the treatment of chronic insomnia: a narrative review of new nonpharmacologic and pharmacologic therapies. Neuropsychiatr Dis Treat. 2021;17:2549–2566. Published 2021 Aug 6. https://doi.org/10.2147/NDT.S297504.

  6. Morin CM, Jarrin DC, Ivers H, Mérette C, LeBlanc M, Savard J. Incidence, persistence, and remission rates of insomnia over 5 years. JAMA Netw Open. 2020;3(11):e2018782. Published 2020 Nov 2. https://doi.org/10.1001/jamanetworkopen.2020.18782.

  7. Bonnet M. Etiology of insomnia. Sleep Med. 2006;7(7):544. https://doi.org/10.1016/j.sleep.2006.05.012.

    Article  PubMed  Google Scholar 

  8. Katz DA, McHorney CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002;51(3):229–35.

    PubMed  Google Scholar 

  9. Andersson C, Vasan RS. Epidemiology of cardiovascular disease in young individuals. Nat Rev Cardiol. 2018;15(4):230–40. https://doi.org/10.1038/nrcardio.2017.154.

    Article  PubMed  Google Scholar 

  10. Sun J, Qiao Y, Zhao M, et al. Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2019: A systematic analysis of Global Burden of Disease Study 2019. BMC Med. 2023;21:222. https://doi.org/10.1186/s12916-023-02925-4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, Forouzanfar MH. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47. https://doi.org/10.1161/CIRCULATIONAHA.113.005119.

    Article  PubMed  Google Scholar 

  12. Lechat B, Appleton S, Melaku YA, et al. Comorbid insomnia and sleep apnoea is associated with all-cause mortality. Eur Respir J. 2022;60(1):2101958. Published 2022 Jul 13. https://doi.org/10.1183/13993003.01958-2021.

  13. Krijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A, Witteman JC M, Stricker BH, Heeringa J. Projections on the number of individuals with atrial fibrillation in the European Union, from. to 2060. Eur Heart J. 2013;34(35):2746–51. https://doi.org/10.1093/eurheartj/eht280.

    Article  Google Scholar 

  14. Hald EM, Løchen ML, Mathiesen EB, et al. Atrial fibrillation, venous thromboembolism, ischemic stroke, and all-cause mortality: the Tromsø study. Res Pract Thromb Haemost. 2020;4(6):1004–1012. Published 2020 Jul 6. https://doi.org/10.1002/rth2.12351.

  15. Fan YY. Effects of sleep deprivation on action potential and transient outward potassium current in ventricular myocytes in rats. Med Sci Monit. 2015;21:542–9. https://doi.org/10.12659/msm.893414.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7–10.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111. https://doi.org/10.1053/smrv.2002.0186.

    Article  PubMed  Google Scholar 

  18. Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40(8):869–93. https://doi.org/10.1016/s0005-7967(01)00061-4.

    Article  CAS  PubMed  Google Scholar 

  19. Rodenbeck A, Hajak G. “Neuroendocrine dysregulation in primary insomnia.” Revue neurologique vol. 157,11 Pt 2. 2001:S57–61.

  20. Chokesuwattanaskul R, Thongprayoon C, Sharma K, Congrete S, Tanawuttiwat T, Cheungpasitporn W. Associations of sleep quality with incident atrial fibrillation: a meta-analysis. Intern Med J. 2018;48(8):964–72. https://doi.org/10.1111/imj.13764.

    Article  PubMed  Google Scholar 

  21. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;(3):354–81. PMID: 8737210.

  22. Cabiddu R, Cerutti S, Viardot G, Werner S, Bianchi AM. Modulation of the sympatho-vagal balance during sleep: frequency domain study of heart rate variability and respiration. Front Physiol. 2012;9(3):45. https://doi.org/10.3389/fphys.2012.00045. PMID: 22416233; PMCID: PMC3299415.

    Article  Google Scholar 

  23. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf JF, Ammash NM, Friedman PA, Somers VK. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364–7. https://doi.org/10.1161/01.CIR.0000136587.68725.8E. Epub 2004 Jul 12 PMID: 15249509.

    Article  PubMed  Google Scholar 

  24. Sari I, Davutoglu V, Ozbala B, Ozer O, Baltaci Y, Yavuz S, Aksoy M. Acute sleep deprivation is associated with increased electrocardiographic P-wave dispersion in healthy young men and women. Pacing Clin Electrophysiol. 2008;31(4):438–42. https://doi.org/10.1111/j.1540-8159.2008.01013.x. PMID: 18373762.

    Article  PubMed  Google Scholar 

  25. Esen Ö, Akçakoyun M, Açar G, Bulut M, Alızade E, Kargin R, Emıroğlu MY, Yazicioğlu MV, Gemici K, Esen AM. Acute sleep deprivation is associated with increased atrial electromechanical delay in healthy young adults. Pacing Clin Electrophysiol. 2011;34(12):1645–51. https://doi.org/10.1111/j.1540-8159.2011.03186.x. Epub 2011 Aug 11 PMID: 21834922.

    Article  PubMed  Google Scholar 

  26. Li J, Vitiello MV, Gooneratne NS. Sleep in normal aging. Sleep Med Clin. 2018;13(1):1–11. https://doi.org/10.1016/j.jsmc.2017.09.001.

    Article  PubMed  Google Scholar 

  27. Arand DL, Burton G, Bonnet MH. When to order a sleep study and how to read the report - Part I. Primary Care Reports. 2002;8:192.

    Google Scholar 

  28. Arand DL, Burton G, Bonnet MH. When to order a sleep study and how to read the report - Part II. Primary Care Reports. 2002;8:200.

    Google Scholar 

  29. Sutton EL. Insomnia. Ann Intern Med. 2021;174(3):ITC33-ITC48. https://doi.org/10.7326/AITC202103160.

  30. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23–36. https://doi.org/10.1016/j.smrv.2014.10.001.

    Article  PubMed  Google Scholar 

  31. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.

    Article  CAS  PubMed  Google Scholar 

  32. Klingman KJ, Jungquist CR, Perlis ML. Questionnaires that screen for multiple sleep disorders. Sleep Med Rev. 2017;32:37–44. https://doi.org/10.1016/j.smrv.2016.02.004.

    Article  PubMed  Google Scholar 

  33. Hauri P. Sleep hygiene. In: Hauri P, editor. Current concepts: the sleep disorders. The Upjohn Company; Kalamazoo, MI: 1977:21–35.

  34. Zarcone VP. Sleep hygiene. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 3rd ed. WB Saunders; Philadelphia, PA. 2000:657–61.

  35. Insomnia treatment: Cognitive behavioral therapy instead of Sleeping Pills. Mayo Clinic. 2023. Accessed July 11, 2023. https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677.

  36. Cognitive Behavioral Therapy for Insomnia (CBTI). Stanford Health Care (SHC) - Stanford Medical Center. Accessed July 11, 2023. https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures.html.

  37. • Rossman J. Cognitive-behavioral therapy for insomnia: an effective and underutilized treatment for insomnia. Am J Lifestyle Med. 2019;13(6):544–547. Published 2019 Aug 12. https://doi.org/10.1177/1559827619867677. This study highlights the prevalence of sleep difficulties and the effectiveness of cognitive-behavioral therapy for insomnia (CBT-i) as a nonpharmacological treatment. CBT-i is shown to be safe and highly effective, but underutilized due to the shortage of trained practitioners and patients’ tendency to learn about sleep medication instead. The authors advocate for physicians to recommend it as a first-line treatment for chronic insomnia.

  38. Sleep disorder (sedative-hypnotic) Drug Information. U.S. Food and Drug Administration. Accessed July 11, 2023. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sleep-disorder-sedative-hypnotic-drug-information.

  39. •• Li X, Zhou T, Ma H, et al. Healthy sleep patterns and risk of incident arrhythmias. J Am Coll Cardiol. 2021;78(12):1197–207. https://doi.org/10.1016/j.jacc.2021.07.023. This prospective study highlights the importance of a healthy sleep pattern in reducing the risks of atrial fibrillation/flutter and bradyarrhythmia. The findings indicate that individuals with a healthier sleep score have a significantly lower risk of developing AF and bradyarrhythmia, independent of traditional risk factors, and the association is influenced by genetic susceptibility to AF. This study emphasizes the potential benefits of considering overall sleep behaviors in assessing cardiac arrhythmia risks.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Han X, Yang Y, Chen Y, et al. Association between insomnia and atrial fibrillation in a Chinese population: a cross-sectional study. Clin Cardiol. 2017;40(9):765–9. https://doi.org/10.1002/clc.22731.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lee HH, Chen YC, Chen JJ, Lo SH, Guo YL, Hu HY. Insomnia and the risk of atrial fibrillation: a population-based cohort study. Acta Cardiol Sin. 2017;33(2):165–72. https://doi.org/10.6515/acs20160611b.

    Article  PubMed  PubMed Central  Google Scholar 

  42. •• Chen CC, Lin CH, Yang TY, et al. Association between sleep disorder and atrial fibrillation: a nationwide population-based cohort study. Sleep Med. 2022;96:50–6. https://doi.org/10.1016/j.sleep.2022.05.002. Important study revealing a strong link between sleep disorders (SDs) and atrial fibrillation (AF), with insomnia showing a higher impact on AF compared to other SDs. Emphasizes the need to address sleep disturbances for AF risk management.

    Article  PubMed  Google Scholar 

  43. Christensen MA, Dixit S, Dewland TA, et al. Sleep characteristics that predict atrial fibrillation. Heart Rhythm. 2018;15(9):1289–95. https://doi.org/10.1016/j.hrthm.2018.05.008.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bae NY, Lee SR, Choi EK, et al. Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study. Cardiovasc Diabetol. 2022;21(1):251. Published 2022 Nov 17. https://doi.org/10.1186/s12933-022-01682-7.

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Authors and Affiliations

  1. B.J.Medical College, Ahmedabad, India

    Parjanya Bhatt

  2. GMERS GOTRI, Vadodara, India

    Vaishnavi Patel

  3. Liaquat National Hospital & Medical College, Karachi, Pakistan

    Jatin Motwani

  4. Shyam Shah Medical College, Hari Bhushan Nagar, Madhya Pradesh, 486001, Rewa, India

    Udit Choubey

  5. Avalon University School of Medicine, Curacao, Willemstad, Netherlands

    Ramsha Mahmood

  6. Dayanand Medical College and Hospital, Ludhiana, India

    Vasu Gupta

  7. Penn State Milton S Hershey Medical Center, Hershey, PA, USA

    Rohit Jain

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Bhatt, P., Patel, V., Motwani, J. et al. Insomnia and Cardiovascular Health: Exploring the Link Between Sleep Disorders and Cardiac Arrhythmias. Curr Cardiol Rep 25, 1211–1221 (2023). https://doi.org/10.1007/s11886-023-01939-x

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