Abstract 14835: The Prevalence of Sleep Disturbance and Its Strong Impact on Depression Symptom in Patients Hospitalized With Cardiovascular Diseases

Abstract

Introduction: There is increasing evidence that sleep disturbance significantly contribute to the development of heart disease. However, sleep disturbance often remains unrecognized and untreated because of barrier to its assessment. The aims of this study were to assess the prevalence of sleep disturbance in cardiovascular patients, and examine its related factors including mental status. Methods and Results: A total of 1087 patients (mean age, 65±15 years; 29% female) hospitalized for a spectrum of cardiovascular diseases in Keio University Hospital were enrolled (coronary artery disease n=348, arrhythmia n=459, heart failure n=81, valvular heart disease n=119, and other n=80). We assessed sleep disturbance using the Pittsburgh Sleep Quality Index (PSQI; mean 5.6±3.3). The sleep disturbance was defined as PSQI>7 (n=256 [24%]). We screened sleep-disordered breathing (SDB) using nocturnal pulse oximetry, a non-invasive method for detecting nocturnal intermittent hypoxia. The prevalence of SDB (3% oxygenation desaturation index>15/hour) was higher in patients with sleep disturbance (33% vs 26%, p=0.02). Sleep disturbance was associated with older age, higher BNP and CRP level, and lower eGFR and albumin level (all p<0.05). Sex, BMI, and the prevalence of hypertension or diabetics mellitus did not differ between patients with sleep disturbances and those without. The patients with sleep disturbance had significantly higher depression (Hospital Anxiety and Depression Scale [HADS]-Depression score; 6.4±3.7 vs 3.7±3.2, p<0.001, PHQ-9; 6.8±4.5 vs 2.7±2.9, p<0.001) and anxiety (HADS-anxiety score; 6.2±3.8 vs 3.6±2.9, p<0.001) symptoms. After adjustment for age, sex, and psychological disturbance, sleep disturbance was associated with heart failure (OR=1.81; P=0.027; 95% CI, 1.06-3.06). Multiple regression analysis revealed that depressive symptom was the most powerful factor related to sleep disturbance (OR=1.2; P<0.0001; 95% CI, 1.12-1.33). Conclusions: Given the high prevalence of sleep disturbances and their strong impact on psychological disturbance, increased efforts should be undertaken for their identification and treatment in patients with cardiovascular diseases, especially in the field of heart failure.