Sairam Parthasarathy1, Monica M Vasquez2, Marilyn Halonen3, Richard Bootzin4, Stuart F Quan5, Fernando D Martinez3, Stefano Guerra6. 1. Department of Medicine, University of Arizona, Tucson; Arizona Respiratory Center, University of Arizona, Tucson. Electronic address: spartha@arc.arizona.edu. 2. Arizona Respiratory Center, University of Arizona, Tucson. 3. Arizona Respiratory Center, University of Arizona, Tucson; BIO5 Institute, University of Arizona, Tucson. 4. Department of Psychology and Psychiatry, University of Arizona, Tucson. 5. Arizona Respiratory Center, University of Arizona, Tucson; Division of Sleep Medicine, Harvard Medical School, Boston, Mass. 6. Department of Medicine, University of Arizona, Tucson; Arizona Respiratory Center, University of Arizona, Tucson; CREAL Centre and Universitat Pompeu Fabra, Barcelona, Spain.
Abstract
BACKGROUND: Insomnia has been associated with mortality risk, but whether this association is different in subjects with persistent vs intermittent insomnia is unclear. Additionally, the role of systemic inflammation in such an association is unknown. METHODS: We used data from a community-based cohort to determine whether persistent or intermittent insomnia, defined based on persistence of symptoms over a 6-year period, was associated with death during the following 20 years of follow-up. We also determined whether changes in serum C-reactive protein (CRP) levels measured over 2 decades between study initiation and insomnia determination were different for the persistent, intermittent, and never insomnia groups. The results were adjusted for confounders such as age, sex, body mass index, smoking, physical activity, alcohol, and sedatives. RESULTS: Of the 1409 adult participants, 249 (18%) had intermittent and 128 (9%) had persistent insomnia. During a 20-year follow-up period, 318 participants died (118 due to cardiopulmonary disease). In adjusted Cox proportional-hazards models, participants with persistent insomnia (adjusted hazards ratio [HR] 1.58; 95% confidence interval [CI], 1.02-2.45) but not intermittent insomnia (HR 1.22; 95% CI, 0.86-1.74) were more likely to die than participants without insomnia. Serum CRP levels were higher and increased at a steeper rate in subjects with persistent insomnia as compared with intermittent (P = .04) or never (P = .004) insomnia. Although CRP levels were themselves associated with increased mortality (adjusted HR 1.36; 95% CI, 1.01-1.82; P = .04), adjustment for CRP levels did not notably change the association between persistent insomnia and mortality. CONCLUSIONS: In a population-based cohort, persistent, and not intermittent, insomnia was associated with increased risk for all-cause and cardiopulmonary mortality and was associated with a steeper increase in inflammation.
BACKGROUND:Insomnia has been associated with mortality risk, but whether this association is different in subjects with persistent vs intermittent insomnia is unclear. Additionally, the role of systemic inflammation in such an association is unknown. METHODS: We used data from a community-based cohort to determine whether persistent or intermittent insomnia, defined based on persistence of symptoms over a 6-year period, was associated with death during the following 20 years of follow-up. We also determined whether changes in serum C-reactive protein (CRP) levels measured over 2 decades between study initiation and insomnia determination were different for the persistent, intermittent, and never insomnia groups. The results were adjusted for confounders such as age, sex, body mass index, smoking, physical activity, alcohol, and sedatives. RESULTS: Of the 1409 adult participants, 249 (18%) had intermittent and 128 (9%) had persistent insomnia. During a 20-year follow-up period, 318 participants died (118 due to cardiopulmonary disease). In adjusted Cox proportional-hazards models, participants with persistent insomnia (adjusted hazards ratio [HR] 1.58; 95% confidence interval [CI], 1.02-2.45) but not intermittent insomnia (HR 1.22; 95% CI, 0.86-1.74) were more likely to die than participants without insomnia. Serum CRP levels were higher and increased at a steeper rate in subjects with persistent insomnia as compared with intermittent (P = .04) or never (P = .004) insomnia. Although CRP levels were themselves associated with increased mortality (adjusted HR 1.36; 95% CI, 1.01-1.82; P = .04), adjustment for CRP levels did not notably change the association between persistent insomnia and mortality. CONCLUSIONS: In a population-based cohort, persistent, and not intermittent, insomnia was associated with increased risk for all-cause and cardiopulmonary mortality and was associated with a steeper increase in inflammation.
Authors: Michael A Grandner; Nirav P Patel; Philip R Gehrman; Michael L Perlis; Allan I Pack Journal: Sleep Med Rev Date: 2009-11-06 Impact factor: 11.609
Authors: Phyllis C Zee; M Safwan Badr; Clete Kushida; Janet M Mullington; Allan I Pack; Sairam Parthasarathy; Susan Redline; Ronald S Szymusiak; James K Walsh; Nathaniel F Watson Journal: Sleep Date: 2014-02-01 Impact factor: 5.849
Authors: Janet M Mullington; Norah S Simpson; Hans K Meier-Ewert; Monika Haack Journal: Best Pract Res Clin Endocrinol Metab Date: 2010-10 Impact factor: 4.690
Authors: Francisco Campos-Rodriguez; Miguel A Martinez-Garcia; Montserrat Martinez; Joaquin Duran-Cantolla; Monica de la Peña; María J Masdeu; Monica Gonzalez; Felix del Campo; Inmaculada Gallego; Jose M Marin; Ferran Barbe; Jose M Montserrat; Ramon Farre Journal: Am J Respir Crit Care Med Date: 2012-11-15 Impact factor: 21.405
Authors: Wessel M A van Leeuwen; Maili Lehto; Piia Karisola; Harri Lindholm; Ritva Luukkonen; Mikael Sallinen; Mikko Härmä; Tarja Porkka-Heiskanen; Harri Alenius Journal: PLoS One Date: 2009-02-25 Impact factor: 3.240
Authors: Omavi Bailey; Daniel Combs; Maria Sans-Fuentes; Cody M Havens; Michael A Grandner; Chithra Poongkunran; Sarah Patel; Sarah Berryhill; Natalie Provencio; Stuart F Quan; Sairam Parthasarathy Journal: J Clin Sleep Med Date: 2019-06-15 Impact factor: 4.062
Authors: Monica M Vasquez; Muhan Zhou; Chengcheng Hu; Fernando D Martinez; Stefano Guerra Journal: Am J Respir Crit Care Med Date: 2017-05-15 Impact factor: 21.405
Authors: Sairam Parthasarathy; Mary A Carskadon; Girardin Jean-Louis; Judith Owens; Adam Bramoweth; Daniel Combs; Lauren Hale; Elizabeth Harrison; Chantelle N Hart; Brant P Hasler; Sarah M Honaker; Elisabeth Hertenstein; Samuel Kuna; Clete Kushida; Jessica C Levenson; Caitlin Murray; Allan I Pack; Vivek Pillai; Kristi Pruiksma; Azizi Seixas; Patrick Strollo; Saurabh S Thosar; Natasha Williams; Daniel Buysse Journal: Sleep Date: 2016-12-01 Impact factor: 5.849
Authors: Janet M Mullington; Sabra M Abbott; Judith E Carroll; Christopher J Davis; Derk-Jan Dijk; David F Dinges; Philip R Gehrman; Geoffrey S Ginsburg; David Gozal; Monika Haack; Diane C Lim; Madalina Macrea; Allan I Pack; David T Plante; Jennifer A Teske; Phyllis C Zee Journal: Sleep Date: 2016-04-01 Impact factor: 5.849
Authors: Daniel B Kay; Helmet T Karim; Adriane M Soehner; Brant P Hasler; Kristine A Wilckens; Jeffrey A James; Howard J Aizenstein; Julie C Price; Bedda L Rosario; David J Kupfer; Anne Germain; Martica H Hall; Peter L Franzen; Eric A Nofzinger; Daniel J Buysse Journal: Sleep Date: 2016-10-01 Impact factor: 5.849