Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Effects of Comorbid Sleep Disorders on Cardiovascular Complications of Hypertension Among Patients With Newly-diagnosed Hypertension: An Analysis of the Korean National Health Insurance Service-National Sample Cohort

  • Kang, Jeongmook (Department of Preventive Medicine, Soonchunhyang University College of Medicine) ;
  • Park, Yoon-Hyung (Department of Preventive Medicine, Soonchunhyang University College of Medicine) ;
  • Yang, Kwang Ik (Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital) ;
  • Cruz, Jose Rene Bagani (Department of Preventive Medicine, Soonchunhyang University College of Medicine) ;
  • Hwangbo, Young (Department of Preventive Medicine, Soonchunhyang University College of Medicine)
  • Received : 2019.09.04
  • Accepted : 2019.11.06
  • Published : 2020.01.31
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Abstract

Objectives: This study investigated the effects of comorbid sleep disorders (SD) on the incidence of cardiovascular complications among newly-diagnosed hypertension (HTN) patients. Methods: As study population, 124 057 newly-diagnosed essential HTN patients aged 30 or older, without cardiovascular complications at diagnosis with HTN, were selected from the National Health Insurance Service-National Sample Cohort. The incidence of cardiovascular complications was calculated, Cox proportional-hazards regression model was used to analyze the risk of complications, and the population attributable fraction (PAF) for cardiovascular complications of having comorbid SD at HTN diagnosis was calculated. Results: Over 10 years, 32 275 patients (26.0%) developed cardiovascular complications. In HTN patients with comorbid SD at diagnosis of HTN, the incidence of cardiovascular complications (78.3/1000 person-years; 95% confidence interval [CI], 75.8 to 80.9) was higher than in those without comorbid SD (58.6/1000 person-years; 95% CI, 57.9 to 59.3) and the risk of cardiovascular complications was 1.21 times higher (95% CI, 1.17 to 1.25), adjusting for age, gender, income, area of residence, and comorbid diabetes mellitus. The PAF of having comorbid SD at diagnosis of HTN for the incidence of cardiovascular complications was 2.07% (95% CI, 1.69 to 2.44). Conclusions: Newly-diagnosed essential HTN patients aged 30 or older who had comorbid SD at the time of their HTN diagnosis had a higher incidence of cardiovascular complications than those without comorbid SD. Age, gender, income, area of residence, and comorbid diabetes mellitus had a significant effect on the incidence of cardiovascular complications. Approximately 2% of cardiovascular complications were found to occur due to the presence of SD.

Keywords

References

  1. Korean Society Hypertension. Korea hypertension fact sheet 2018 [cited 2019 Sep 1]. Available from: http://www.koreanhypertension.org/reference/guide?mode=read&idno=4166 (Korean).
  2. World Health Organization. Raised blood pressure [cited 2019 Sep 1]. Available from: https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/.
  3. Harrison TR, Isselbacher KJ, Wilson JD. Harrison's principles of internal medicine. 19th ed. New York: McGraw-Hill; 2015, p. 1825.
  4. Statistics Korea. Cause of death in Korea 2017 [cited 2019 Aug 14]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&aSeq=370710&pageNo=1&rowNum=10&amSeq=&sTarget=&sTxt= (Korean).
  5. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 2011;32(12):1484-1492. https://doi.org/10.1093/eurheartj/ehr007
  6. Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I. Insomnia and the risk of incident heart failure: a population study. Eur Heart J 2014;35(21):1382-1393. https://doi.org/10.1093/eurheartj/eht019
  7. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc Sci Med 2010;71(5):1027-1036. https://doi.org/10.1016/j.socscimed.2010.05.041
  8. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365(9464): 1046-1053. https://doi.org/10.1016/S0140-6736(05)74229-X
  9. Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF. Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 2014;21(1):57-64. https://doi.org/10.1177/2047487312460020
  10. Stores G, Wiggs L. Sleep disturbance in children and adolescents with disorders of development: its significance and management. London: Cambridge University Press; 2001, p. 16.
  11. American Academy of Sleep Medicine. International classification of sleep disorders; 2014 [cited 2019 Sep 1]. Available from: https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2019/05/ICSD3-TOC.pdf.
  12. HIRA Web Magazine. Theme disease - sleep disorder; 2018 Jun 15 [cited 2019 Aug 14]. Available from: https://m.post.naver.com/viewer/postView.nhn?volumeNo=16050604&memberNo=1891127&searchKeyword=%EC%83%9D%EC%B2%B4%EC%8B%9C%EA%B3%84&searchRank=340 (Korean).
  13. Woo JM, Hyun SY, Lee SH, Kang SG, Lee JS, Kim L, et al. Productivity time lost by sleep disturbance among workers in Korea. J Korean Neuropsychiatr Assoc 2011;50(1):62-68 (Korean).
  14. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol 2017;46(2):e15. https://doi.org/10.1093/ije/dyv319
  15. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82(8A):2N-9N. https://doi.org/10.1016/S0002-9149(98)00583-9
  16. Allan V, Honarbakhsh S, Casas JP, Wallace J, Hunter R, Schilling R, et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation? A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb Haemost 2017;117(5):837-850. https://doi.org/10.1160/th16-11-0825
  17. Dzeshka MS, Shantsila A, Shantsila E, Lip GY. Atrial fibrillation and hypertension. Hypertension 2017;70(5):854-861. https://doi.org/10.1161/HYPERTENSIONAHA.117.08934
  18. Saksena S. Camm AJ, Electrophysiological disorders of the heart. 2nd ed. Philadelphia: Elsevier Health Sciences; 2011, p. 572.
  19. White PD, Rickards H, Zeman AZ. Time to end the distinction between mental and neurological illnesses. BMJ 2012;344: e3454. https://doi.org/10.1136/bmj.e3454
  20. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999;100(10):1134-1146. https://doi.org/10.1161/01.CIR.100.10.1134
  21. Leon BM, Maddox TM. Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 2015;6(13):1246- 1258. https://doi.org/10.4239/wjd.v6.i13.1246
  22. Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension 2001;37(4): 1053-1059. https://doi.org/10.1161/01.hyp.37.4.1053
  23. Newson RB. Attributable and unattributable risks and fractions and other scenario comparisons. Stata J 2013;13(4):672-698. https://doi.org/10.1177/1536867x1301300402
  24. Dyken ME, Im KB. Obstructive sleep apnea and stroke. Chest 2009;136(6):1668-1677. https://doi.org/10.1378/chest.08-1512
  25. Selvi Y, Aydin A, Gumrukcuoglu HA, Gulec M, Besiroglu L, Ozdemir PG, et al. Dream anxiety is an emotional trigger for acute myocardial infarction. Psychosomatics 2011;52(6):544-549. https://doi.org/10.1016/j.psym.2011.04.002
  26. Wolk R, Gami AS, Garcia-Touchard A, Somers VK. Sleep and cardiovascular disease. Curr Probl Cardiol 2005;30(12):625-662. https://doi.org/10.1016/j.cpcardiol.2005.07.002
  27. Koo DL, Nam H, Thomas RJ, Yun CH. Sleep disturbances as a risk factor for stroke. J Stroke 2018;20(1):12-32. https://doi.org/10.5853/jos.2017.02887
  28. Wallace DM, Ramos AR, Rundek T. Sleep disorders and stroke. Int J Stroke 2012;7(3):231-242. https://doi.org/10.1111/j.1747-4949.2011.00760.x
  29. Mims KN, Kirsch D. Sleep and stroke. Sleep Med Clin 2016;11(1): 39-51. https://doi.org/10.1016/j.jsmc.2015.10.009
  30. Park E. Assessment on concictency of KCD codes and medical record and methods for improvement. Wonju: Health Insurance Review and Assessment Service; 2017, p. 79-81 (Korean).
  31. Ah YM, Lee JY, Choi YJ, Kim B, Choi KH, Kong J, et al. Persistence with antihypertensive medications in uncomplicated treatment-naive patients: effects of initial therapeutic classes. J Korean Med Sci 2015;30(12):1800-1806. https://doi.org/10.3346/jkms.2015.30.12.1800
  32. Lee SG, Jeon SY. The knowledge, attitude and practice of blood pressure management from the patient's viewpoint: a qualitative study. J Prev Med Public Health 2008;41(4):255-264 (Korean). https://doi.org/10.3961/jpmph.2008.41.4.255