Association between Insomnia Symptoms and Risk of Heart Failure: A Meta-analysis of Prospective Cohort Studies

BackgroundInsomnia, as one of the most prevalent sleep disorders, is frequently linked to Heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. ObjectiveThis updated meta-analysis aimed to evaluate the associations between HF and various insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening (EMA) and non-restorative sleep (NRS). MethodsA comprehensive literature search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library to identify prospective cohort studies from inception to October 2023. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Eggers tests were employed to assess publication bias. ResultsA total of 177,008 patients from seven eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (95% CI:1.09-1.45; P=0.001), indicating that insomnia was associated with increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with risk of HF (HR:1.14, 95% CI:1.04-1.25; P=0.005). DMS and NRS had no significant effect on the risk of HF (P>0.05). In the subgroup analysis including age, sex and BMI, there were no significant differences between each group. ConclusionThis meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF. Clinical PerspectiveWhat is new? Insomnia is ubiquitous and seriously affects peoples normal work, life, and health. At present, prospective cohort studies have suggested that insomnia can increase the risk of heart failure (HF). However, in our meta-analysis, we firstly found that only Difficulty Initiating Sleep (DIS) was directly associated with an increased HF incidence, rather than other insomnia subtypes. This is a very interesting which suggests that DIS has a greater impact on the incident of HF. In addition, this points us that in the subsequent treatment of insomnia, maybe we should pay more attention to the treatment of DIS. What are the clinical implications? As insomnia symptoms can be assessed and identified early and are relatively manageable, the study of the relationship between insomnia and HF has potential important clinical significance. If further research confirms that the improvement of insomnia symptoms, especially DIS symptoms, contributes to the prevention of HF or the prognosis of HF patients, it will provide another new "track" for the prevention and treatment of HF.