Comparison of Actigraphic and Subjective Measures of Sleep in Implantable Cardioverter Defibrillator and Coronary Artery Disease Patients

Abstract

Background:Cardiac patients frequently have insomnia symptoms that may pose risk for future cardiac events. Poor sleep relates to hyperarousal, anxiety and depression, and the incidence of hypertension and myocardial infarction.Hypothesis:The authors hypothesized that implantable cardioverter defibrillator (ICD) patients would have poorer sleep than coronary artery disease (CAD) patients related to hypervigilance for device functioning and shock discharge.Methods:Authors investigated sleep efficiency and sleep latency in a sample of 60 patients (n = 30 CAD and n = 30 ICD) without obstructive sleep apnea at the University of Florida & Shands Hospital. For 14 days, participants completed a sleep diary. Additionally, half of the total sample also used actigraphy to objectively measure their sleep. Measures of somatic hypervigilance and psychosocial distress were administered.Results:Using actigraphy, mean sleep efficiency was poorer (69.76%) in CAD patients compared with ICD patients (82.80%). This difference was highly significant, F1,27 = 16.840, P < 0.001. CAD patients also had shorter mean total sleep times per sleep diaries compared with ICD patients (336.19 minutes or 5.60 hours, 430.65 minutes or 7.18 hours, respectively), F1,27 = 15.908, P < 0.001.Conclusions:The finding that ICD patients slept more efficiently than CAD patients is surprising given that CAD patients had higher ejection fractions and no concerns about ICD shocks. This difference cannot be accounted for by differences in hypervigilance, depression, anxiety, or physical activity. Results suggest that CAD patients may have more sleep problems and may warrant increased research attention. Copyright © 2010 Wiley Periodicals, Inc.Dr. Sears serves as a consultant to Medtronic, has or has had research grants from Medtronic and St. Jude Medical, and has received speaker honoraria from Medtronic, Boston Scientific, St. Jude Medical, and Biotronik. Dr. Conti serves as a consultant to Medtronic, has or has had research grants from Medtronic and St. Jude Medical, and has received speaker honoraria from Medtronic, Boston Scientific, and St. Jude Medical. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs)

“…The prevalence rate of OSA in our sample (40.5%) is consistent with previous findings in the literature (40–77%; Fries et al, 1999; Grimm et al, 2013; Mehra et al, 2006; Serizawa et al, 2008; Tomaello et al, 2010), although our rate of OSA and comorbid insomnia (11.9%) is low relative to previously reports in ICD patients with nocturnal ventricular arrhythmias (22–54.9%; Al-Jawder & Bahammam, 2011). Our prevalence rate for insomnia within the sample (28.6%) is lower but somewhat comparable to previous findings in heart failure patients (44%; Taylor et al, 2007), and suggests that insomnia is a considerable problem with these patients as a less-recognized and/or treated condition that until recently has received little attention (Cross et al, 2010). …”

“…Only one such study, performed by Cross, McCrae, Smith, Conti and Sears (2010), has looked at the prevalence of diagnosable insomnia in this population. That study found that ICD patients reported mean sleep onset latencies (33.8 min) and wake times after sleep onset (32.6 min) consistent with empirically-validated quantitative criteria for diagnosing insomnia (K.…”

Cognitive Behavioral Treatment of Insomnia

“…41 , 42 Patients with implantable cardioverter-defi brillator (ICD) devices also show clinically signifi cant levels of sleep disruption. 34 Patients with ICDs are at an increased risk for clinically signifi cant anxiety, which is related to hypervigilance, shock anxiety, and fear of device malfunction, 34 , 43 , 44 placing these patients at increased risk for insomnia.…”

“…For example, among patients with ICDs, concerns about receiving a shock in the middle of the night may lead to increased emotional and physiologic arousal, which can interfere with sleep. 34 …”

Sleep Quality and Sleepiness in Persons with Implantable Cardioverter Defibrillators: Outcome from a Clinical Randomized Longitudinal Trial

“…Sleep‐disordered breathing has also been related to ICD shock 20,21 . Even though sleep problems are found more frequently in cardiac patients with coronary heart disease than in patients with an ICD, 22 sleep remains an important and little studied area of concern.…”