Clinical Correlates of Insomnia in Patients With Acute Coronary Syndrome

Abstract

SummaryThis study sought to examine the prevalence of insomnia and its association with depression, anxiety, and medical comorbidities in patients after an acute coronary syndrome (ACS). Insomnia increases risk of recurrent cardiac events in ACS patients, but little is known about the prevalence and clinical correlates of insomnia in this setting. Patients (n = 102, 58.3 ± 10.6 years-old) admitted for ACS to a cardiology service at an urban academic medical center completed the Insomnia Severity Index, Epworth Sleepiness Scale, and measures of depression and anxiety. A subset (n = 20) completed ambulatory polysomnography (PSG) in their homes several weeks after discharge. Moderate or severe insomnia was reported by 37% of patients during hospitalization and was associated with 76 minutes more wake after sleep onset measured by home PSG. Although depression and insomnia were strongly associated, about 1 in 4 patients with insomnia did not report significant depressive symptoms. Sleep apnea was documented in 80% of patients on PSG, but insomnia was not associated with sleep apnea, periodic limb movements, demographic factors, or medical conditions other than liver disease. Insomnia is present in over one-third of ACS patients during hospitalization, but at-risk patients could not be readily identified by demographic or medical factors or by depression symptoms. (Int Heart J 2013; 54: 258-265) Key words: Sleep, Myocardial infarction, Angina, Depression A s many as 1 in 3 patients with acute coronary syndrome (ACS) suffer from significant psychological distress, such as depression and anxiety.1,2) Among ACS patients, depression and anxiety are associated with increased mortality, 3,4) diminished quality of life, 5) increased health care costs, 6) and reduced adherence to recommendations intended to decrease the risk of cardiac events. 7) Although insomnia is common among individuals with psychological distress, the literature on depression and anxiety as risk factors for ACS morbidity and mortality has largely ignored its potential impact in ACS patients. Instead, most of the literature on sleep in patients with heart disease has focused almost exclusively on sleep apnea due to known associations between sleep-disordered breathing (SDB) and cardiovascular morbidity. 8) Insomnia, however, is often unrelated to SDB 9,10) and is important to consider in ACS patients since poor sleep quality is associated with a 2.5-fold increased risk of recurrent cardiac events in women after an ACS.11) Insomnia has also been linked to increased morbidity, 12) mortality, 13) and health care costs 14) independent of psychological distress and in some cases, independent of SDB and periodic limb movements as well. 12)To our knowledge, no study has examined insomnia in an ACS population using a reliable, validated self-report instrument of insomnia severity that not only assesses sleep continuity and quality, but also inquires about important consequences of poor sleep, such as daytime impairment or distress.15-17) As such, this study ...

Influence of Cognitive Behavioral Therapy on Mood and Quality of Life After Stent Implantation in Young and Middle-Aged Patients With Coronary Heart Disease

“…The pathogenesis of depression and anxiety has not been fully clarified, and both biological and psychological factors might be involved. [26][27][28] However, psychological interventions in young and middle-aged coronary heart In the present study, the combination of CBT and drug treatment was used to maximize the improvement of symptoms and enhance efficacy. In the CBT process, therapists help patients understand that the psychological obstacles come from dysfunction of their own information processing systems.…”

Relationships between coronary angiography, mood, anxiety and insomnia

“…Instead, research on sleep in patients with heart disease has mainly focused on sleep apnea due to the well-established associations between sleep-disordered breathing (SDB) and cardiovascular morbidity (Coryell et al, 2013). We hypothesized in the current study that an invasive diagnostic procedure such as CA may cause anxiety and insomnia as a result, and insomnia causing anxiety may be completing a vicious cycle.…”

Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography

“…type II devices, including EEG channels) has been introduced (Bruyneel and Ninane, ). Type II devices are intended to offer a complete sleep evaluation in an unattended surrounding at the patients’ homes, allowing not only the diagnosis of sleep‐disordered breathing (Banhiran et al ., ; Bruyneel et al ., ; Campbell and Neill, ; Portier et al ., ) but also other sleep disorders, for example, periodic leg movements during sleep (Kushida et al ., ), insomnia (Coryell et al ., ) and sleep bruxism (Doering et al ., ). It is demonstrated that when a patient sleeps in a familiar environment, sleep is more representative than that in the sleep laboratory (Bruyneel et al ., ; Iber et al ., ).…”