Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis

Suzanne M Bertisch; Michelle Reid; Pamela L Lutsey; Joel D Kaufman; Robyn McClelland; Sanjay R Patel; Susan Redline

doi:10.1093/sleep/zsab116

Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis

Sleep. 2021 Oct 11;44(10):zsab116. doi: 10.1093/sleep/zsab116.

Authors

Suzanne M Bertisch^{1

2

3}, Michelle Reid¹, Pamela L Lutsey⁴, Joel D Kaufman⁵, Robyn McClelland⁶, Sanjay R Patel⁷, Susan Redline^{1

2

3}

Affiliations

¹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.
² Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴ Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
⁵ Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA.
⁶ Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
⁷ Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

Study objectives: To quantify the gender-specific associations between insomnia symptoms and subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, which has strong predictive value for incident cardiovascular disease.

Methods: We analyzed data from 1,429 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants completed standardized questionnaires and underwent polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as: self-reported trouble falling, staying or returning to sleep, early-morning awakenings, or hypnotic use, for ≥5 nights/week. MESA assessed CAC using computed tomography. We employed multivariable linear regression to model the probability of CAC >0 overall and to model the linear continuous effect among those with nonzero CAC.

Results: Our sample was a mean age of 68.1 ± 9.1 years, 53.9% female, and 36.2% white, 28.0% black, 24.2% Hispanic, and 11.5% Chinese-American. Insomnia symptoms were present in 49.7% of men and 47.2% of women. In multivariable-adjusted analyses, insomnia symptoms was associated with an 18% higher prevalence of CAC (PR 1.18, 95% CI 1.04, 1.33) among females, but no association was observed among males (PR 1.00, 95% CI 0.91, 1.08). There was no evidence that the association between insomnia symptoms and prevalence of CAC >0 differed by objective sleep duration status (by single-night PSG or multi-night actigraphy) in females or males.

Conclusions: We found that among women, insomnia symptoms were associated with an 18% higher prevalence of CAC compared to no insomnia. Insomnia symptoms were not associated with CAC prevalence in men. Additionally, there was no evidence that the association between insomnia symptoms and CAC score >0 differed by objective short sleep duration status.

Keywords: cardiovascular disease; epidemiology; gender differences; insomnia; sleep duration.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Atherosclerosis*
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / epidemiology
Coronary Vessels / diagnostic imaging
Female
Humans
Male
Middle Aged
Risk Factors
Sex Factors
Sleep Initiation and Maintenance Disorders* / epidemiology

Abstract

Publication types

MeSH terms

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