失眠作为 HIV 患者心血管疾病发病的独立预测因子：来自退伍军人老龄化队列研究的数据。
Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV: Data From the Veterans Aging Cohort Study.
机构信息
Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN.
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
出版信息
J Acquir Immune Defic Syndr. 2019 May 1;81(1):110-117. doi: 10.1097/QAI.0000000000001981.
BACKGROUND
Insomnia is associated with increased cardiovascular disease (CVD) risk in the general population and is highly prevalent in people with HIV. The CVD risk conferred by insomnia in the HIV population is unknown.
METHODS
Using the Veterans Aging Cohort Study Survey Cohort, insomnia symptoms were measured and dummy coded with the item, "Difficulty falling or staying asleep?" (5-point scale from no difficulty to bothers a lot). Incident CVD event ICD-9 codes (acute myocardial infarction, stroke, or coronary artery revascularization) were identified with the Department of Veterans Affairs (VA) and Medicare administrative data and VA fee-for-service data. Those with baseline CVD were excluded.
RESULTS
HIV-infected (N = 3108) veterans had a median follow-up time of 10.8 years, during which 267 CVD events occurred. Compared to HIV-infected veterans with no difficulty falling or staying asleep, HIV-infected veterans bothered a lot by insomnia symptoms had an increased risk of incident CVD after adjusting for demographics [hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.16 to 2.31, P = 0.005], CVD risk factors (HR = 1.62, 95% CI: 1.14 to 2.30, P = 0.007), additional potential confounders (hepatitis C infection, renal disease, anemia, alcohol use, and cocaine use; HR = 1.70, 95% CI: 1.19 to 2.43, P = 0.003), and HIV-specific factors (HIV-1 RNA, CD4 T-cell count, and antiretroviral therapy; HR = 1.66, 95% CI: 1.16 to 2.37, P = 0.005). Additional adjustment for nonbenzodiazepine sleep medication (HR = 1.62, 95% CI: 1.13 to 2.32, P = 0.009) did not attenuate the association; however, it fell short of significance at P < 0.01 after adjustment for depressive symptoms (HR = 1.51, 95% CI: 0.98 to 2.32, P = 0.060) or antidepressant medication (HR = 1.51, 95% CI: 1.04 to 2.19, P = 0.031).
CONCLUSIONS
Highly bothersome insomnia symptoms were significantly associated with incident CVD in HIV-infected veterans, suggesting that insomnia may be a novel, modifiable risk factor for CVD in HIV.
背景
失眠与普通人群的心血管疾病（CVD）风险增加有关，在 HIV 感染者中也非常普遍。然而，失眠在 HIV 人群中导致的 CVD 风险尚不清楚。
方法
使用退伍军人老龄化队列研究调查队列，使用项目“入睡或保持睡眠困难？”（5 分制，从无困难到困扰很多）测量失眠症状并进行虚拟编码。使用退伍军人事务部（VA）和医疗保险管理数据以及 VA 按服务收费数据确定心血管疾病事件 ICD-9 代码（急性心肌梗死、中风或冠状动脉血运重建）。排除基线时有 CVD 的患者。
结果
感染 HIV 的（N=3108）退伍军人的中位随访时间为 10.8 年，在此期间发生了 267 例 CVD 事件。与入睡或保持睡眠无困难的 HIV 感染退伍军人相比，失眠症状严重困扰的 HIV 感染退伍军人在调整人口统计学因素后，发生 CVD 的风险增加（风险比[HR]为 1.64，95%置信区间[CI]为 1.16 至 2.31，P=0.005）、心血管疾病危险因素（HR=1.62，95%CI：1.14 至 2.30，P=0.007）、其他潜在混杂因素（丙型肝炎感染、肾脏疾病、贫血、酒精使用和可卡因使用；HR=1.70，95%CI：1.19 至 2.43，P=0.003）以及 HIV 特异性因素（HIV-1 RNA、CD4 T 细胞计数和抗逆转录病毒治疗；HR=1.66，95%CI：1.16 至 2.37，P=0.005）。进一步调整非苯二氮䓬类睡眠药物（HR=1.62，95%CI：1.13 至 2.32，P=0.009）并没有削弱这种关联；然而，在调整抑郁症状（HR=1.51，95%CI：0.98 至 2.32，P=0.060）或抗抑郁药物（HR=1.51，95%CI：1.04 至 2.19，P=0.031）后，该关联不再显著。
结论
严重困扰的失眠症状与 HIV 感染退伍军人的 CVD 事件显著相关，这表明失眠可能是 HIV 患者 CVD 的一个新的、可改变的危险因素。
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