Sleep Duration, Sleep Quality, and Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction Pubblico

Fang, Shuyang (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/n009w280q?locale=it
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Abstract

Background: Both abnormal sleep duration and poor sleep quality are associated with high cardiovascular disease mortality and adverse outcomes after myocardial infarction (MI); and an increased predisposition toward emotionally provoked myocardial ischemia may play a role. We investigated the independent and joint associations of sleep duration, and sleep quality with mental stress-induced myocardial ischemia among young MI survivors.

Methods: We studied 145 participants (64 women and 81 men) age 38 - 60 years who were hospitalized for acute MI in the previous 8 months. Patients underwent myocardial perfusion scans at rest, after mental stress, and after physical stress. Myocardial perfusion defects scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest perfusion defect scores, was used to quantify the perfusion defects. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep duration and sleep quality, which were analyzed as separate and combined scores.

Results: There was a U-shaped association between sleep duration and stress-induced myocardial ischemia (both mental and physical stress). After adjustment for relevant confounders, both short and long sleepers were found to have a higher probability of developing mental stress-induced myocardial ischemia (MSIMI) ("<= 5 h" OR: 1.62, 95% CI: (0.41, 6.50); "6 h" OR 2.11, 95% CI: (0.54, 8.32); ">= 8 h" OR 3.17, 95% CI: (0.81, 12.4)). Patients with poor sleep quality were also found to be associated with higher risk of MSIMI (OR: 1.31; 95% CI: 0.49 - 3.45). However, all the associations found above were not statistically significant.

Conclusion: In this pilot study we found preliminary evidence that abnormal sleep duration and poor sleep quality may be directly associated with mental stress induced myocardial ischemia in younger post MI patients, even though this association was not statistically significant.

Table of Contents

Background. 1

Methods. 6

Results. 14

Discussion. 18

References. 21

Tables. 29

Table 1. Characteristics of participants by sleep duration and sleep quality. 29

Table 2. Characteristics of Pittsburgh Sleep Quality Index component scores by Sleep duration. 31

Table 3. Characteristics of Pittsburgh Sleep Quality Index sleep variables by sleep duration. 32

Table 4. Associations of sleep duration, sleep quality with Mental Stress Induced myocardial Ischemia (MSIMI) incidence and Physical Stress Induced Myocardial Ischemia (PSIMI) incidence. 33

Table 5. Associations of sleep duration, sleep quality with Mental Stress Induced Myocardial Ischemia (MSIMI) severity and Physical Stress Induced Myocardial Ischemia (PSIMI) severity. 34

Table 6. Unadjusted associations between PSQI component scores and Mental Stress Induced Myocardial Ischemia (MSIMI) severity and Physical Stress Induced Myocardial Ischemia (PSIMI) severity. 35

Table 7. Multivariate adjusted Associations between PSQI component scores and Mental Stress Induced Myocardial Ischemia (MSIMI) severity and Physical Stress Induced Myocardial Ischemia (PSIMI) severity. 36

Table 8. Unadjusted Associations between PSQI component and Mental Stress Induced Myocardial Ischemia (MSIMI) incidence and Physical Stress Induced Myocardial Ischemia (PSIMI) incidence. 37

Table 9. Multivariate adjusted Associations between PSQI sleep component and Mental Stress Induced Myocardial Ischemia (MSIMI) incidence and Physical Stress Induced Myocardial Ischemia (PSIMI) incidence. 38

Table 10. Interaction between Sleep Duration, Sleep Quality, other Sleep variables and Obesity, in relation to Mental Stress Induced Myocardial Ischemia (MSIMI). 39

Table 11. Interaction between Sleep Duration, Sleep Quality, other Sleep Variables, and Obesity, in relation to Physical Stress Induced Myocardial Ischemia (PSIMI). 40

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