Do insomnia complaints cause hypertension or cardiovascular disease?

OBJECTIVE We prospectively investigated odds ratios (ORs) for development of hypertension or cardiovascular disease by endorsement of sleep complaints. METHODS The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, population-based study of cardiovascular disease. Our study sample was 8757 ARIC participants without hypertension and 11,863 ARIC participants without cardiovascular disease at baseline. We applied multivariate regression analysis to predict the ORs of development of hypertension or cardiovascular disease over 6 years of follow-up by endorsement of symptoms of difficulty falling asleep (DFA), waking up repeatedly (SCD), awakening tired and fatigued (NRS), or combinations of these symptoms. We controlled for age, sex, alcohol intake, income, smoking, diabetes, heart disease, menopausal status, depression, educational level, Body Mass Index, respiratory symptoms, and pulmonary function. RESULTS Endorsement of all 3 sleep complaints predicted a slightly increased risk of cardiovascular disease (OR 1.5, 1.1-2.0) but not of hypertension. Endorsement of either DFA or SCA predicted slightly increased risk of hypertension (OR 1.2, 1.03-1.3) CONCLUSIONS The definition of insomnia affects its impact. A combination of 3 sleep complaints (DFA, SCD, NRS) predicted a slightly increased risk of cardiovascular disease but not hypertension, and a complaint of either DFA or SCD predicted increased hypertensive risk. It is not clear whether these modest and inconsistent effects are of clinical significance.