Canivet Catarina, Nilsson Peter M, Lindeberg Sara I, Karasek Robert, Östergren Per-Olof
Lund University, Social Medicine and Global Health, Malmö, Sweden.
Internal Medicine, Department of Clinical Sciences Malmö, Lund University, Sweden.
J Psychosom Res. 2014 Apr;76(4):292-9. doi: 10.1016/j.jpsychores.2014.02.001. Epub 2014 Feb 11.
Insomnia and short and long sleep durations have all been linked to cardiovascular disease. Male gender and low socioeconomic status are also related to cardiovascular disease, but it is unclear whether these two factors modify the impact of poor sleep on cardiovascular disease incidence.
Participants (5875 men and 7742 women ages 45 to 64 with no history of cardiovascular disease from the general population of Malmö, Sweden; participation rate 41%) were enrolled from 1992 to 1994 and followed until 2005 or until the first cardiovascular event (defined as myocardial infarction, stroke, or death due to ischemic heart disease), as recorded by official registers. Baseline blood pressure, BMI, and inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with hazard ratios (HRs) of cardiovascular events.
Affirming 'moderate' or 'considerable' problems with at least one out of the four insomnia symptoms was associated with cardiovascular event in women (fully-adjusted HR 1.4 [95% CI 1.2-1.6] and population attributable fraction 17.3%). The same was true of men with past or present manual occupation (HR 1.3 [95% CI 1.1-1.6] and population attributable fraction 11.8%). The HRs increased further in women where insomnia symptoms were combined with short or long sleep duration.
Insomnia is a significant public health problem with implications for cardiovascular disease incidence. Taking gender and socioeconomic status into account is a worthwhile approach in research on sleep and cardiovascular disease outcomes.
失眠以及睡眠时间过短和过长均与心血管疾病有关。男性性别和社会经济地位低下也与心血管疾病相关，但尚不清楚这两个因素是否会改变睡眠不佳对心血管疾病发病率的影响。
研究对象为1992年至1994年从瑞典马尔默普通人群中招募的无心血管疾病史的45至64岁参与者（5875名男性和7742名女性；参与率41%），随访至2005年或直至首次发生心血管事件（定义为心肌梗死、中风或因缺血性心脏病死亡），相关信息由官方登记记录。将基线血压、体重指数以及有关社会心理状况和自我报告睡眠习惯的询问数据与心血管事件的风险比（HRs）进行比较。
女性中，肯定存在四种失眠症状中至少一种的“中度”或“相当严重”问题与心血管事件相关（完全调整后的HR为1.4 [95%可信区间1.2 - 1.6]，人群归因分数为17.3%）。过去或现在从事体力劳动的男性情况相同（HR为1.3 [95%可信区间1.1 - 1.6]，人群归因分数为11.8%）。在失眠症状与睡眠时间过短或过长同时存在的女性中，HRs进一步升高。
失眠是一个重大的公共卫生问题，对心血管疾病发病率有影响。在睡眠与心血管疾病结局的研究中，考虑性别和社会经济地位是一种值得采用的方法。
