Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis

Background: Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. Methods: PubMed, Scopus, and Web of Science were searched using terms; such as “Insomnia” and “MI.” Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. Results: Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41–2.02, p <.00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7−8 h of sleep (RR = 1.56, 95% CI = 1.41–1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04–1.23, p =.003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91–1.23, p =.46). Analysis of age, follow-up duration, sex, and comorbidities showed a significant association in insomniacs. Conclusion: Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.