Insomnia Symptoms and Acute Coronary Syndrome-Induced Posttraumatic Stress Symptoms: A Comprehensive Analysis of Cross-sectional and Prospective Associations

Abstract

Background Acute coronary syndrome (ACS) induces clinically significant posttraumatic stress symptoms (PTSS) in 12% of patients. Subjective sleep problems are a risk factor for the development of PTSS, but this is underexplored in patients with ACS. Purpose To examine the association of insomnia symptoms with ACS-induced PTSS. Methods In this longitudinal study with 154 patients (all white, 84.4% male, mean age 58.7 years) with a verified ACS, insomnia symptoms were interviewer assessed at hospital admission and at 3 months, using the Jenkins Sleep Scale (JSS)-4. ACS-induced PTSS were assessed with the Clinician-Administered Posttraumatic Stress Disorder Scale 3 months after hospital admission. In multivariable linear models, insomnia symptoms were regressed on PTSS, adjusting for demographics, clinical variables, health behaviors, and psychological data, including cognitive depressive symptoms. Results Greater insomnia symptoms at admission (β = .165, p = .034), greater increase in insomnia symptoms from admission to 3 months (β = .233, p = .008), and greater insomnia symptoms at 3 months (β = .239, p = .002) were independently associated with more severe total PTSS at 3 months. Concerning the individual PTSS clusters, both insomnia symptoms at admission (β = .214, p = .007) and at 3 months (β = .213, p = .012) were independently associated with reeexperiencing symptoms. Removing sleep items from PTSS scores and excluding patients on antidepressants in two sensitivity analyses did not substantially change the results. Conclusions Insomnia symptoms could play an important role in the development and severity of ACS-induced PTSS. This relationship seems not simply explained by the fact that sleeping difficulties are inherent to the phenotype of posttraumatic stress disorder. Clinical Trial information NCT01781247.

Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome

“…Difficulty falling or staying asleep, or restless sleep, is a component of a diagnostic criterion for PTSD (Criterion E) (3). Whereas prior work has demonstrated cross-sectional (37) and prospective (36) associations of both poor sleep quality and insomnia symptoms with ACS-induced PTSD, this is the first study to estimate the bidirectional influence between sleep duration and cardiac event or hospitalization-induced PTSD symptoms, and to assess this association multiple times over 1 year. Findings from secondary analysis suggest that the association between sleep duration and PTSD symptoms observed here is not solely due to the inclusion of sleep parameters counting toward the composite PCL score, because the sleep duration–PTSD relationship persisted when sleep-related items (i.e., insomnia symptoms and nightmares) were removed from the PCL.…”

“…Two studies to date have examined the association between sleep and cardiac event-induced PTSD symptoms, with one focusing on the prospective association of insomnia symptoms and subsequent PTSD symptoms (36) and the other focusing on the cross-sectional association between poor sleep quality and PTSD symptoms (37). In both cases, poor sleep/ insomnia symptoms were associated with greater PTSD symptoms.…”

Nomogram for Predicting the Risk of Short Sleep Duration in Myocardial Infarction Survivors

“…The prevalence of insomnia is increasing [ 10 ]. Insomnia can lead to the development of MI, and MI can lead to the development of insomnia [ 11 , 12 , 13 ]. Prolonged and reduced sleep durations are both linked to higher mortality rates, and the presence of insomnia symptoms further exacerbates deaths related to cardiovascular disease [ 14 , 15 ].…”

Pre‐pandemic sleep reactivity prospectively predicts distress during the COVID‐19 pandemic: The protective effect of insomnia treatment

“…Importantly, sleep disturbances serve as barriers to adapting to adversity, augmenting emotional sensitivity and increasing perceived stress (Krause et al, 2017 ). For instance, sleep disturbances following trauma are associated with increased risk for symptoms of depression and posttraumatic stress disorder (PTSD) (Cox et al, 2017 ; Fan et al, 2017 ; Kim et al, 2021 ; Koren et al, 2002 ; von Känel et al, 2021 ). Yet, it is unclear who is at greatest risk of developing these sleep disturbances following exposure to potential trauma, hindering our ability to optimally prevent their downstream effects.…”