Association between insomnia symptoms and risk of heart failure: A meta-analysis of prospective cohort studies

Objective Insomnia, as one of the most prevalent sleep disorders, is frequently linked to Heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. This meta-analysis aims to provide a comprehensive and current evaluation of the associations between insomnia symptoms and heart failure (HF) risk HF and various insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening (EMA), and non-restorative sleep (NRS). Methods and results A comprehensive literature search was conducted in PubMed, Web of Science, Embase, ProQuest and the Cochrane Library to identify prospective cohort studies from inception to October 31, 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Egger's tests were employed to assess publication bias. A total of 177,008 patients from 7 eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (95% CI: 1.09–1.45; P  = 0.001), indicating that insomnia was associated with an increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with the risk of HF (HR: 1.14, 95% CI: 1.04–1.25; P  = 0.005). DMS and NRS had no significant effect on the risk of HF ( P  > 0.05). In the subgroup analysis including age, sex, and body mass index, there were no significant differences between groups. Conclusion This meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF.