Divorce and insomnia after menopause have major health implications

A new study has found that stressful life events and insomnia are linked to an increased risk of irregular heart rhythms in postmenopausal women.

After menopause, an estimated 1 in 4 women may develop irregular heart rhythms – known as atrial fibrillation – in their lifetime, with stressful life events, such as divorce or illness, and insomnia being major contributing factors.

Atrial fibrillation may lead to blood clots, stroke, heart failure or other cardiovascular complications.

The research, published today in the Journal of the American Heart Association, reviewed data from more than 83,000 women aged 50-79 from the Women’s Health Initiative, a major US study.

‘In my general cardiology practice, I see many postmenopausal women with picture perfect physical health who struggle with poor sleep and negative psychological emotional feelings or experience, which we now know may put them at risk for developing atrial fibrillation,’ said lead study author Dr Susan X Zhao.

‘I strongly believe that in addition to age, genetic and other heart-health related risk factors, psychosocial factors are the missing piece to the puzzle of the genesis of atrial fibrillation.’

Participants were asked a series of questions about stressful life events, their sense of optimism, social support and insomnia.

Questions about stressful life events addressed topics such as losing a loved one, illness, divorce, financial pressure, and domestic, verbal, physical or sexual abuse.

The study also explored the women’s sleeping habits, outlook on life, and having friends to talk with during stressful situations.

During approximately a decade of follow-up, the study found that 23,954 women – about 25% – developed atrial fibrillation.

For each additional point on the insomnia scale, there is a 4% higher likelihood of developing atrial fibrillation. Similarly, for each additional point on the stressful life event scale, there is a 2% higher likelihood of having atrial fibrillation.

‘The heart and brain connection has been long established in many conditions,’ said Dr Zhao. ‘Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes stemming from stress and poor sleep. These common pathways likely underpin the association between stress and insomnia with atrial fibrillation.’

Researchers noted that stressful life events, poor sleep and feelings, such as depression, anxiety or feeling overwhelmed by one’s circumstances, are often interrelated.

It’s difficult to know whether these factors accumulate gradually over the years to increase the risk of atrial fibrillation as women age.

Chronic stress has not been consistently associated with atrial fibrillation, and the researchers note that a limitation of their study is that it relied on patient questionnaires used at the start of the study.

Stressful life events, however, though significant and traumatic, may not be long lasting, Dr Zhao noted. Further research is needed to confirm these associations and evaluate whether customized stress-relieving interventions may modify atrial fibrillation risk.

Atrial fibrillation primarily affects older adults and the number of people diagnosed with atrial fibrillation has increased by 50% in a decade, according to the British Heart Foundation.

The new total means that 1 in 45 people in the UK are known to be living with the condition.

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