Insomnia and Its Association with Cardiovascular Risk in Adults of a Primary Care Unit in Tijuana

Mini Review

J Fam Med. 2020; 7(2): 1194.

Insomnia and Its Association with Cardiovascular Risk in Adults of a Primary Care Unit in Tijuana

Rodriguez-Banuelos MA*, Coria-Chavez K, Salazar-Galindo T, Vargas-Guzman DK, Velazquez-Corona SS and Sanchez-Parada L

Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

*Corresponding author: Rodriguez-Banuelos Mayra Alejandra, Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

Received: December 14, 2019; Accepted: January 29, 2020; Published: February 05, 2020


Background: In Mexico, it is estimated that 30% of the population has some sleep disorder and insomnia corresponds to 39%. There is evidence to suggest that insomnia may be related to the occurrence of cardiovascular diseases.

Objective: To know the frequency of insomnia and its association with cardiovascular risk.

Design and Setting: Analytic cross-sectional study.

Methods: The Athens survey was applied to form two groups of patients (with and without insomnia), in each group the Framingham scale was performed to calculate cardiovascular risk. The results were analyzed with the statistical program SPSS v21; in the bivariate analysis, odds ratio and Chi-square were used, with a 95% confidence interval; a p<0.05 was considered significant.

Results: 424 patients were recruited; the average age was 55.8 ± 9.4 years. The incidence of insomnia was 36%. The incidence of low cardiovascular risk was 10%, moderate risk 62%, high risk 20% and very high risk 8%. No association was found between insomnia and cardiovascular risk (p>0.05).

Conclusion: The incidence of insomnia was similar to that reported nationally in previous studies and there was no statistical significance between insomnia and cardiovascular risk.

Keywords: Insomnia; Sleep disorders; Cardiovascular risk 


Sleep is defined as the state of unconsciousness from which a person can be awakened by sensory or other stimuli [1]. Insomnia is a sleep disorder in which there is a difficulty in initiating or maintaining sleep or reaching a duration and quality capable of replenishing energy and normal waking state [2]. The International Classification of Diseases 10 (CIE-10) requires for its diagnosis that in addition to the difficulty in starting or maintaining sleep, not having a restful sleep, it lasts at least one month and that in addition, it is accompanied by daytime fatigue, sensation of significant personal unrest and social, labor or other important areas of personal activity [3].

Lack of sleep affects the functions of the central nervous system, prolonged wakefulness is associated with a progressive dysfunction of mental processes and sometimes leads to abnormal behaviors. Sleep restores levels of brain activity and the normal balance between the various functions of the central nervous system. Excessive use of some brain areas during wakefulness are able to easily break the natural balance between neuronal centers [2-3]. It is believed that the adverse cardiovascular effects of sleep disorders are mediated by their effects on the sympathetic nervous system and the activation of the renin-angiotensin system, the deregulation of the hypothalamic-adrenal axis and the chronic increase in systemic inflammation. In addition, the independent or interactive association between insomnia and depression, as well as anxiety and the risk of cardiovascular disease remains uncertain [4].

Worldwide, the prevalence of these disorders varies between 10 and 60%, depending on the diagnostic criteria used and the characteristics of the population; insomnia is the most common disorder [5]. According to the World Health Organization, 40% of the population has insomnia at some time in their life [6]. In Mexico there are few epidemiological studies related to sleep pathology. It is estimated that about 30% of Mexicans suffer from a sleep disorder [7-8].

Cardiovascular risk is defined as the probability of a clinical cardiac event over a period of 10 years [9]. Most cardiovascular diseases can be prevented by acting on risk factors such as smoking, diet, obesity, sedentary lifestyle and excessive alcohol consumption [6,10]. Cardiovascular diseases are the leading cause of death worldwide, with an estimated prevalence rate of 30-35%. Research in the past 20 years has shown evidence that suggests insomnia may be associated with the presence of cardiovascular disease [8,11]. The objective of the research was to know the frequency of insomnia and its relationship with cardiovascular risk in adults in the family medical unit #27 of Tijuana, Mexico.


Study design and population

An analytical cross-sectional study was conducted in the family medicine unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, Baja California, Mexico; in a period between December 2018 and August 2019. Patients from 40 to 80 years of age who attended medical evaluation for any reason, who agreed to participate in the study by informed consent and who had at least one measurement of total cholesterol in the last 6 months were included. Patients who did not know how to read and write, those with a history of ischemic heart disease and those who were being treated with benzodiazepines or sleep inducers were excluded. Incomplete surveys were eliminated.