Prognostic Significance of Insomnia in Heart Failure

Yuki Kanno; Akiomi Yoshihisa; Shunsuke Watanabe; Mai Takiguchi; Tetsuro Yokokawa; Akihiko Sato; Shunsuke Miura; Takeshi Shimizu; Yuichi Nakamura; Satoshi Abe; Takamasa Sato; Satoshi Suzuki; Masayoshi Oikawa; Shu-ichi Saitoh; Yasuchika Takeishi

doi:10.1253/circj.CJ-16-0205

Heart Failure

Prognostic Significance of Insomnia in Heart Failure

Yuki Kanno, Akiomi Yoshihisa, Shunsuke Watanabe, Mai Takiguchi, Tetsuro Yokokawa, Akihiko Sato, Shunsuke Miura, Takeshi Shimizu, Yuichi Nakamura, Satoshi Abe, Takamasa Sato, Satoshi Suzuki, Masayoshi Oikawa, Shu-ichi Saitoh, Yasuchika Takeishi

Author information

Yuki Kanno
Department of Cardiology and Hematology, Fukushima Medical University
Akiomi Yoshihisa
Department of Cardiology and Hematology, Fukushima Medical University
Department of Advanced Cardiac Therapeutics, Fukushima Medical University
Shunsuke Watanabe
Department of Cardiology and Hematology, Fukushima Medical University
Mai Takiguchi
Department of Cardiology and Hematology, Fukushima Medical University
Tetsuro Yokokawa
Department of Cardiology and Hematology, Fukushima Medical University
Akihiko Sato
Department of Cardiology and Hematology, Fukushima Medical University
Shunsuke Miura
Department of Cardiology and Hematology, Fukushima Medical University
Takeshi Shimizu
Department of Cardiology and Hematology, Fukushima Medical University
Yuichi Nakamura
Department of Cardiology and Hematology, Fukushima Medical University
Satoshi Abe
Department of Cardiology and Hematology, Fukushima Medical University
Takamasa Sato
Department of Cardiology and Hematology, Fukushima Medical University
Satoshi Suzuki
Department of Cardiology and Hematology, Fukushima Medical University
Department of Advanced Cardiac Therapeutics, Fukushima Medical University
Masayoshi Oikawa
Department of Cardiology and Hematology, Fukushima Medical University
Shu-ichi Saitoh
Department of Cardiology and Hematology, Fukushima Medical University
Yasuchika Takeishi
Department of Cardiology and Hematology, Fukushima Medical University
Department of Advanced Cardiac Therapeutics, Fukushima Medical University

Keywords: Exercise capacity, Heart failure, Insomnia, Prognosis, Renin-angiotensin-aldosterone system

JOURNAL FREE ACCESS FULL-TEXT HTML

2016 Volume 80 Issue 7 Pages 1571-1577

DOI https://doi.org/10.1253/circj.CJ-16-0205

Editorial (80-7 pp. 1525-1526)

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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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