Abstract
BackgroundObstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of OSA as well as insomnia symptoms are associated with neuroendocrine hormones and coagulation factors in patients admitted with acute myocardial infarction.MethodsWe assessed 190 patients (mean age 60 years, 83% men) in terms of OSA risk (STOP screening tool for the assessment of high vs. low OSA risk) and severity of insomnia symptoms (Jenkins Sleep Scale for the assessment of subjective sleep difficulties) within 48 h of an acute coronary intervention. Circulating concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured the next morning. The association of OSA risk and insomnia symptoms with neuroendocrine hormones and coagulation factors was computed using multivariate models adjusting for demographic factors, health behaviors, somatic and psychiatric comorbidities, cardiac disease-related variables, and OSA risk in the model for insomnia symptoms, respectively, for insomnia symptoms in the model for OSA risk.ResultsHigh OSA risk was identified in 41% of patients and clinically relevant insomnia symptoms were reported by 27% of patients. Compared to those with low OSA risk, patients with high OSA risk had lower levels of epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001). More severe insomnia symptoms were associated with higher levels of fibrinogen (p = 0.037), driven by difficulties initiating sleep, and with lower levels of norepinephrine (p = 0.024), driven by difficulties maintaining sleep.ConclusionsIn patients with acute myocardial infarction, sleep problems are associated with neuroendocrine hormones and coagulation activity. The pattern of these relationships is not uniform for patients with a high risk of OSA and those with insomnia symptoms, and whether they contribute to adverse cardiovascular outcomes needs to be established.Trial registrationClinicalTrials.gov NCT01781247.
Highlights
Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease
We focused on circulating neuroendocrine and coagulation markers in patients with sleep problems admitted with acute myocardial infarction (MI), as sleep studies in individuals without Cardiovascular disease (CVD) suggest a role of neuroendocrine changes and coagulation activation in incident atherothrombotic events
A total of 77 (40.5%) patients could be identified with a high OSA risk; 15 (78.9%) of the 19 patients with a history of sleep apnea were in this group
Summary
Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. Obstructive sleep apnea and insomnia symptoms, including difficulty initiating sleep, difficulty maintaining sleep and non-restorative sleep, have been associated with an increased risk of incident coronary heart disease (CHD) events, independently of a range of other risk factors [3,4,5,6,7]. In men who had undergone percutaneous coronary angioplasty, a state of vital exhaustion, characterized by subjective sleep disturbances, including troubles falling asleep, waking up repeatedly during the night, and not feeling well rested, along with profound feelings of fatigue, was predictive of new CHD events after a follow-up of 1.5 years [12]
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