Sleep Quality, Sleep Duration, and the Risk of Adverse Clinical Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Abstract

BackgroundMyocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with varying underlying etiologies and occurs in ~5–10% of patients with acute myocardial infarction. Sleep disorders and short sleep duration are common phenomena experienced by patients with coronary heart disease and are associated with poor clinical outcomes. However, the association between sleep quality, sleep duration, and the MINOCA prognosis is less clear.MethodsWe performed a prospective observational study of 607 patients with MINOCA between February 2016 and June 2018. The mean follow-up period was 3.9 years. Sleep quality and sleep duration were measured by the Chinese version of the Pittsburgh Sleep Quality Index. The primary endpoint was all-cause mortality, and the secondary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke and heart failure hospitalization.ResultsDuring the follow-up period, all-cause death occurred in 69 participants and 105 participants developed MACE. The Kaplan–Meier survival analysis demonstrated a significant association between poor sleep quality and all-cause mortality (log-rank P = 0.005) and MACE (log-rank P = 0.004). Multivariable Cox regression model indicated that poor sleep quality was an independent predictor of all-cause mortality as well as MACE [adjusted hazard ratio (HR) = 1.649; 95% confidence interval (CI), 1.124–2.790; P < 0.001; and adjusted HR = 1.432; 95% CI, 1.043–2.004; P = 0.003, respectively]. For sleep duration, short sleep duration (<6 h/d) was significantly associated with an increased risk of all-cause mortality and MACE (adjusted HR = 1.326; 95% CI, 1.103–1.812; P = 0.004; and adjusted HR = 1.443; 95% CI, 1.145–1.877; P < 0.001, respectively), whereas long sleep duration was not (>8 h/d). A poorer sleep profile (including poor sleep quality and short sleep duration) was associated with a 149.4% increased risk of death (HR = 2.494; 95% CI, 1.754–4.562; P < 0.001) and a 96.7% increased risk of MACE (HR = 1.967; 95% CI, 1.442–3.639; P < 0.001) than those with neither.ConclusionSleep disorders were common among Chinese patients with MINOCA. Poor sleep quality and short sleep duration were independently associated with an increased risk of all-cause mortality and MACE in the MINOCA population. Meanwhile, a poor sleep profile has an additive effect with regard to cardiovascular risks; in these populations, efforts should be made to improve both sleep quality and sleep duration for secondary cardiovascular prevention.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier: ChiCTR2000040701.

Sleep duration and risk of cardio-cerebrovascular disease: A dose-response meta-analysis of cohort studies comprising 3.8 million participants

“…Overall, 57 articles with 3.2 million participants about CVD were included in our meta-analysis ( 4 – 12 , 19 – 66 ). A U-shaped relationship was found between CVD and the nighttime sleep duration category ( P non–linearity < 0.0001; Figure 2A ).…”

Sleep Quality Among Patients with Myocardial Infarction

“…Sound sleep is a kind of tonic for human health as it lowers the risk of heart disease. Many evidences show that poor sleep is linked to the coronary artery disease and MI, [12][13][14] and little is done so far to assess the sleep qualities among patients with STEMI and those with NSTEMI. STEMI is considered more harmful than NSTEMI and hence needs immediate intervention.…”

“…[4][5][6][7][8][9][10][11] Besides this, poor sleep quality, short sleep duration and overnight shift work are also associated with all-cause mortality and major adverse cardiovascular events in patients with MI. [12][13][14] Good sleep is vital for a healthy heart. Deep sleep reduces stress on the heart by slowing the heart rate, dropping the blood pressure and calming breathing that allow the heart to recover from strain that occurs during waking hours.…”

The Impact of Sleep Quality on Mood Status and Quality of Life in Patients with Alopecia Areata: A Comparative Study

“…On the other hand, insomnia and sleep disorders are frequent among the general population [ 5 ] and have been associated with a variety of cardiovascular [ 6 ], neurologic [ 7 ] or psychiatric [ 8 ] complications. Moreover, a worse sleep quality has been described in a variety of chronic skin diseases such as psoriasis [ 9 ], atopic dermatitis [ 10 ] or chronic spontaneous urticaria [ 11 ].…”