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Investigating the causal interplay between sleep traits and risk of acute myocardial infarction: a Mendelian
Nikhil Arora1,2, Laxmi Bhatta3,4,5, Eivind Schjelderup Skarpsno6,7
1K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. nikhil.arora@ntnu.no.
Background:
Few studies have investigated the joint effects of sleep traits on the risk of acute myocardial infarction (AMI). No previous study has used factorial Mendelian randomization (MR) which may reduce confounding, reverse causation, and measurement error. Thus, it is prudent to study joint effects using robust methods to propose sleep-targeted interventions which lower the risk of AMI.
Methods:
The causal interplay between combinations of two sleep traits (including insomnia symptoms, sleep duration, or chronotype) on the risk of AMI was investigated using factorial MR. Genetic risk scores for each sleep trait were dichotomized at their median in UK Biobank (UKBB) and the second survey of the Trøndelag Health Study (HUNT2). A combination of two sleep traits constituting 4 groups were analyzed to estimate the risk of AMI in each group using a 2×2 factorial MR design.
Results:
In UKBB, participants with high genetic risk for both insomnia symptoms and short sleep had the highest risk of AMI (hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.03, 1.18), although there was no evidence of interaction (relative excess risk due to interaction (RERI) 0.03; 95% CI -0.07, 0.12). These estimates were less precise in HUNT2 (HR 1.02; 95% CI 0.93, 1.13), possibly due to weak instruments and/or small sample size. Participants with high genetic risk for both a morning chronotype and insomnia symptoms (HR 1.09; 95% CI 1.03, 1.17) and a morning chronotype and short sleep (HR 1.11; 95% CI 1.04, 1.19) had the highest risk of AMI in UKBB, although there was no evidence of interaction (RERI 0.03; 95% CI -0.06, 0.12; and RERI 0.05; 95% CI -0.05, 0.14, respectively). Chronotype was not available in HUNT2.
Conclusions:
This study reveals no interaction effects between sleep traits on the risk of AMI, but all combinations of sleep traits increased the risk of AMI except those with long sleep. This indicates that the main effects of sleep traits on AMI are likely to be independent of each other.
Insights
Combinations of sleep traits like insomnia and short sleep increase acute myocardial infarction (AMI) risk, though effects appear independent. Long sleep did not elevate AMI risk in this factorial Mendelian randomization study.
Area of Science:
- Cardiovascular Epidemiology
- Sleep Science
- Genetic Epidemiology
Background:
- Limited research exists on the combined impact of sleep traits on acute myocardial infarction (AMI) risk.
- Factorial Mendelian randomization (MR) has not been previously applied to investigate these joint effects, presenting an opportunity to mitigate confounding and bias.
- Understanding these relationships is crucial for developing targeted sleep interventions to reduce AMI incidence.
Purpose of the Study:
- To investigate the causal interplay between combinations of two sleep traits (insomnia symptoms, sleep duration, chronotype) and the risk of AMI using factorial MR.
- To assess whether the effects of sleep traits on AMI risk are independent or interactive.
- To identify specific sleep trait combinations associated with altered AMI risk.
Main Methods:
- A 2x2 factorial Mendelian randomization design was employed using genetic risk scores for insomnia symptoms, sleep duration, and chronotype.
- Data from the UK Biobank (UKBB) and the Trøndelag Health Study (HUNT2) were utilized.
- Genetic risk scores were dichotomized at the median, and combinations of traits were analyzed to estimate AMI risk.
Main Results:
- In UKBB, individuals with high genetic risk for both insomnia symptoms and short sleep showed the highest AMI risk (HR 1.10).
- High genetic risk for morning chronotype combined with insomnia symptoms or short sleep also elevated AMI risk in UKBB (HRs 1.09 and 1.11, respectively).
- No statistically significant evidence of interaction between sleep traits on AMI risk was observed in either cohort.
Conclusions:
- While no significant interactions were found, combinations of certain sleep traits (excluding long sleep) were associated with increased AMI risk.
- The findings suggest that the primary effects of individual sleep traits on AMI risk are likely independent.
- These results underscore the importance of addressing individual sleep issues to mitigate cardiovascular risk.
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