Cardiovascular Complications of Sleep Disorders: A Better Night’s Sleep for a Healthier Heart / From Bench to Bedside

Abstract

Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increase health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.

Self‐care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology

“…There is no evidence regarding the use of melatonin in HF. Zopiclone is used more frequently and is generally considered safer than benzodiazepines 74,75 …”

Vaccine‐induced immune thrombotic thrombocytopenia after vaccination against Covid‐19: A clinical dilemma for clinicians and patients

“…In any Covid‐19 vaccinated patient who presents with symptoms of thrombosis, such as shortness of breath, lower limb swelling, unusual abdominal pain, unexplained subcutaneous bleeding, confusion and double vision, during the first 4–20 days post‐vaccination, VITT should be highly suspected. 76 Complete blood count and peripheral blood smear, a prothrombin time, partial thromboplastin time, and D‐dimer, fibrinogen and anti‐PF4 IgG (ELISA method) antibody levels should be checked. 78 Moreover, based on the clinical suspicion, an appropriate imaging modality, such as computed tomography (CT) venography, brain CT scan, MRI venography or colour Doppler ultrasound, should be performed.…”

“…46 Therefore, any symptom or sign indicating thrombosis, including back pain, headache, gait imbalance, paraesthesia, hemiparesis or hemiplegia, drowsiness, or visual disturbance, should be taken seriously and evaluated with extra caution. 76 It is noteworthy that some symptoms, such as headaches for one or 2 days and other flu-like symptoms like myalgia and arthralgia, are expected consequences of vaccination and should not be overestimated or concerning. Nonetheless, if any of the symptoms mentioned above last for more than three days, further assessments are mandated.…”

“…CVT ( 9) SVT ( 3) PTE ( 3) PVT ( 1) ICH ( 1) IVC ( 1) AAT CVST ( 2) ICH ( 4) CVT ( 1) PVT ( 1) SVT ( 1) AVT should be highly suspected. 76 Complete blood count and peripheral blood smear, a prothrombin time, partial thromboplastin time, and Ddimer, fibrinogen and anti-PF4 IgG (ELISA method) antibody levels should be checked. 78 Moreover, based on the clinical suspicion, an appropriate imaging modality, such as computed tomography (CT) venography, brain CT scan, MRI venography or colour Doppler ultrasound, should be performed.…”

Adverse Effect of Insomnia on Blood Lipids in Patients With Hypertension

“…Insomnia is a risk factor for the development of arterial hypertension, obesity, type 2 diabetes mellitus, cardiac rhythm disorders, and myocardial infarction [1]. At the same time, insomnia is one of the most frequent non-cardiac complaints in patients with cardiovascular diseases.…”