Interactive Associations of Depression and Sleep Apnea With Adverse Clinical Outcomes After Acute Myocardial Infarction

Abstract

Objective Depression and sleep apnea (SA) are common among patients after acute myocardial infarction (AMI), and both are associated with increased risk for adverse outcomes. We tested the hypothesis that there is an interaction between depression and SA in relation to prognosis in post-AMI patients. Methods Participants were 337 depressed and 379 nondepressed post-AMI patients who participated in a substudy of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. SA was identified from Holter ECG at the entry by an algorithm that detects cyclic variation of heart rate. Results During a median follow-up of 25 months, 43 (6.0%) of patients died and 83 (11.6%) either died or experienced a recurrent AMI. Among 94 patients with both depression and SA, these endpoints occurred in 20 (21.3%) and 25 (26.6%), the prevalence that was 6.9 and 3.9 times higher than predicted probabilities by ENRICHD clinical risk scores (P <.001 for both). In the patients with depression alone, SA alone, or neither, the frequencies did not differ significantly from the predicted probability. Although both depression and SA predicted death and the combined endpoint, we observed depression by SA interactions (P = .03 and .02). SA independently predicted these endpoints in depressed (P <.001 and P = .001), but not in nondepressed patients (P = .73 and .84). Similarly, depression independently predicted these endpoints in SA (P <.001 for both), but not in non-SA patients (P = .61 and .12). Conclusion The combination of depression and SA estimated by CVHR is associated with long-term adverse clinical outcomes after AMI.

Relationship between sleep disturbance, depression and anxiety in the 12 months following a cardiac event

“…In patients recovering from cardiac events such as acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS), the reported prevalence of sleep disorders is considerably higher than in the general population (Banack et al, 2014;Ludka, Galkova, Spinar, & Kara, 2012). There is also evidence that sleep disorders are associated with anxiety and depression in cardiac rehabilitation patients (Banack et al, 2014;Hayano et al, 2012). Further, it is known that depression is associated with treatment non-adherence (DiMatteo, Lepper, & Croghan, 2000) and reduced self-efficacy in cardiac patients (Howarter, Bennett, Barber, Gessner, & Clark, 2014;Steca et al, 2013).…”

A Study of the Psychological and Family Factors Associated with Sleep Quality among Pregnant Women

“…The studies that have been recently performed on depression among patients with respiratory disorders while sleeping have reported a high prevalence of depression among patients (Baran & Richert, 2003;Hayano et al, 2012). It is believed that depression, anxiety and stress affect the quality of sleep (MohammadiFarrokhran et al, 2012).…”

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…84 In addition, they had slower recovery of functional abilities and longer stay in rehabilitation units. 10,85 These outcomes can lead to increased caregiving needs at home, nursing home placement, or death, 86 and may have detrimental effects on rehabilitation 64,87 and long-term outcome. 88 Functional independence in personal care activities can be measured using the motor subscale of the Functional Independence Measure (mFIM), 89 which is widely used in rehabilitation settings to assess functional limitations and changes in functional status with rehabilitation therapy.…”

“…92,93 These patients are less adherent to rehabilitation programs because of decreased functional capacity 94 and depression. 64,87 Poor sleep and fatigue are associated with neuropsychiatric and cognitive disturbances, and result in worse outcomes in rehabilitation and quality of life. 95 Depression after stroke occurs in 30% to 60% of patients with stroke 96 and poor sleep strongly correlates with health complaints and depressive symptoms.…”