Identifying the potential role of insomnia on multimorbidity: A Mendelian randomization phenome-wide association study in UK Biobank

Objectives: To identify the breadth of potential causal effects of insomnia on health outcomes and hence its possible role in multimorbidity. Design: Mendelian randomisation (MR) Phenome-wide association study (MR-PheWAS) with two-sample Mendelian randomisation follow-up. Setting: Individual data from UK Biobank and summary data from a number of genome-wide association studies. Participants: 336,975 unrelated white-British UK Biobank participants. Exposures: Standardised genetic risk of insomnia for the MR-PheWAS and genetically predicted insomnia for the two-sample MR follow-up, with insomnia instrumented by a genetic risk score (GRS) created from 129 single-nucleotide polymorphisms (SNPs). Main outcomes measures: 11,409 outcomes from UK Biobank extracted and processed by an automated pipeline (PHESANT). Potential causal effects (i.e., those passing a Bonferroni-corrected significance threshold) were followed up with two-sample MR in MR-Base, where possible. Results: 437 potential causal effects of insomnia were observed for a number of traits, including anxiety, stress, depression, mania, addiction, pain, body composition, immune, respiratory, endocrine, dental, musculoskeletal, cardiovascular and reproductive traits, as well as socioeconomic and behavioural traits. We were able to undertake two-sample MR for 71 of these 437 and found evidence of causal effects (with directionally concordant effect estimates across all analyses) for 25 of these. These included, for example, risk of anxiety disorders (OR=1.55 [95% confidence interval (CI): 1.30, 1.86] per category increase in insomnia), diseases of the oesophagus/stomach/duodenum (OR=1.32 [95% CI: 1.14, 1.53]) and spondylosis (OR=1.57 [95% CI: 1.22, 2.01]). Conclusion: Insomnia potentially causes a wide range of adverse health outcomes and behaviours. This has implications for developing interventions to prevent and treat a number of diseases in order to reduce multimorbidity and associated polypharmacy.