Introduction: There is increasing evidence that sleep disturbances may lead to adverse cardiovascular disease (CVD) outcomes. Therefore, documenting sleep disturbances at health check-ups may improve CVD risk assessments. However, nationwide evidence in Asian populations remains limited. Objective: To investigate the association between sleep disturbances and incident CVD among individuals who underwent health check-ups using a nationwide Japanese medical claims database. Methods: A retrospective cohort study was conducted using the DeSC database (DeSC Healthcare, Inc), containing medical claims and check-up data from April 2014 to June 2024. Adults aged 40-74 years old who underwent a health check-up between April 2014 and May 2023 were enrolled and followed via linked insurance claims ensuring at least one year of follow-up data. Sleep disturbance was defined as those with regular use of sleep medication at baseline, serving as an indicator for serious insomnia symptoms. The primary outcome was a first CVD hospitalization event due to a CVD diagnosis (I00-I99) via the ICD-10. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events associated with baseline sleep disturbances, adjusting for age, sex, diabetes, hypertension, dyslipidemia, obesity, smoking status, and alcohol intake. Subanalyses excluding those with baseline sleep apnea/narcolepsy, known independent risk factors of CVD, were also conducted. Model discrimination was evaluated using Harrell’s C-index. Results: A total of 2,014,700 individuals (mean age 59.4±10.0 years; 56.0% female) were included for analysis. At baseline, 99,514 (4.9%) participants had evidence of sleep disturbance. Mean follow-up was 45.6±30.7 months, during which 77,952 participants had a CVD event. Cox models displayed that baseline sleep disturbances were associated with an elevated risk of CVD compared to those without (HR: 1.71, 95% CI: 1.67-1.76). Results excluding those with sleep apnea/narcolepsy also produced consistent findings. The model had an acceptable C-index of 0.705. Conclusion: Individuals with sleep disturbances at baseline had a higher risk of developing CVD during follow-up. Sleep disturbances severe enough to require sleep medication may indicate underlying conditions associated with an elevated risk of CVD. These findings suggest that assessing sleep disturbances at health check-ups may be useful for future CVD risk stratification.
Ono et al. (Tue,) studied this question.