The Association of Insomnia and the Subsequent Cerebrovascular Accident in the Hypertension Population

Background/Aim: Hypertension is a vascular condition associated with an increased risk of cerebrovascular accidents (CVAs). Insomnia has also been linked to various neurological disorders, including CVA. Therefore, this study aimed to investigate the potential association between insomnia and subsequent CVA development in a hypertensive population. Patients and Methods: A retrospective cohort study was conducted, enrolling patients with hypertension who were then categorized into groups based on the presence or absence of insomnia. Each group comprised 244, 397 patients. The primary outcomes were the occurrences of CVAs, including both ischemic and hemorrhagic strokes. Cox proportional hazards regression analysis was used to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for these outcomes to compare the insomnia and non-insomnia groups. Results: There were 22, 608 ischemic strokes and 3, 390 hemorrhagic strokes in the non-insomnia group, compared to 22, 669 ischemic strokes and 3, 484 hemorrhagic strokes in the insomnia group. The incidence of ischemic stroke (aHR=1.063; 95%CI=1.041-1.085; p<0.001) and hemorrhagic stroke (aHR=1.154; 95%CI=1.093-1.218; p<0.001) was significantly higher in the insomnia group. Kaplan–Meier analysis showed that the cumulative probability of both ischemic and hemorrhagic stroke was significantly greater in the insomnia group (p<0.001 for both). Sensitivity analyses revealed that the increased risk of ischemic stroke in the Asian population and the increased risk of hemorrhagic stroke among African individuals, patients aged 20-44 years, and those with low HDL levels were not statistically significant. Conclusion: In individuals with hypertension, the presence of insomnia is associated with a significantly higher risk of both ischemic and hemorrhagic stroke.