Anxiety and cardiovascular symptoms: The modulating role of insomnia

Background: Anxiety and insomnia are associated with cardiovascular (CV) symptoms. We assessed whether the relation between anxiety and CV symptoms is modulated by insomnia. Methods: Independently living women (n = 1,440; mean age = 59.36 ± 6.53 years) were recruited by cluster sampling technique. We obtained data on demographic characteristics, health beliefs, access to health care, CV symptoms, sleep, stress and anxiety levels. Results: Overall, 56% of the sample reported insomnia; 46% reported CV symptoms, and 54% were highly anxious. There was a greater likelihood for highly anxious women and those experiencing insomnia to report CV symptoms (r_s = 0.31 ^* and r_s = 0.32^*, respectively). In logistic regression analysis, the adjusted odds ratios for reporting CV symptoms were 1.39 for patients with insomnia and 2.79 for those with anxiety. With control for insomnia, we observed a 3-fold reduction in the magnitude of the association between anxiety and CV symptoms (r_p = 0.09 ^*). Stepwise adjustments for sociodemographic factors, CV risk markers, and factors anchoring health beliefs nd access to health care showed lesser impact on the relationships. With simultaneous control for those covariates, the correlation was r_p = 0.13^*; ^* p < 0.01. Conclusion: The association of CV symptoms with anxiety is partly accounted for by insomnia.