The Role of Sleep Disturbance, Depression and Anxiety in Frail Patients with AF-Gender Differences.

Beata Jankowska-Polańska,Agnieszka Sławuta,Krzysztof Dudek,Jacek Gajek,Jacek Polański,Grzegorz Mazur

doi:10.3390/jcm10010011

Abstract

The aim of the study was to assess the link between anxiety and depression and frailty syndrome (FS) in patients with atrial fibrillation (AF) with regard to gender differences. Material and methods. The study was conducted on 158 patients with AF (mean age 70.4 ± 7.6). The study used the hospital anxiety and depression scale (HADS-M), the Athens insomnia scale (AIS) and the Edmonton frailty scale to assess and compare anxiety, depression, and sleep disturbance between frail and non-frail patients with AF. Results. FS was diagnosed in 53.2% of patients. A comparative analysis showed a statistically significantly higher severity level of anxiety (12.0 ± 2.6 vs. 8.4 ± 2.5, p < 0.001) and depression (12.5 ± 2.5 vs. 7.2 ± 3.3, p < 0.001) in frail patients compared to non-frail patients. The analysis of the level of anxiety, depression and FS did not show any significant differences between the studied women and men. However, statistically, significant differences were observed when FS occurred, regardless of gender. Anxiety disorders were observed in 75.5% of patients with FS and in 16.7% without frailty, whereas depressive disorders were observed in 73.6% of frail patients and in 4.2% without frailty. In an analysis of the impact of cumulative variables on the level of frailty, the risk of FS in patients with anxiety/depression and sleep disturbance is almost 500 times higher compared to patients without anxiety/depression and sleep disturbance. The risk of frailty in patients with sleep disturbance only is thirteen times higher than in the reference group, i.e., in patients without depression/anxiety and sleep disturbances. Conclusions: Patients with AF and FS show deeper anxiety, depression and sleep disturbances. Gender does not influence the risk of frailty in AF patients. Frailty in patients with AF is associated with a higher risk of depression, sleep disturbances and anxiety.

Highlights

One in four hospitalized elderly patients have atrial fibrillation (AF) [1].The condition is more common with age, affecting 17% of 80-year-olds
The results showed that a higher proportion of patients with frailty syndrome (FS) compared to patients without frailty had an abnormal level of anxiety
The logistic regression coefficients for FS and the sociodemographic and clinical characteristics analyzed in this study showed that independent determinants of FS include the duration of AF of more than five years, as well as the presence of depression, anxiety and sleep disturbance

Summary

Introduction

One in four hospitalized elderly patients have atrial fibrillation (AF) [1].The condition is more common with age, affecting 17% of 80-year-olds. In addition to somatic problems relating to the symptoms of heart failure, many patients complain of deteriorated mood and sleep disturbance. The feeling of palpitations relating to an irregular heart rate may cause significant problems falling asleep, especially in those patients who prefer to sleep on their left side. The co-occurrence of those problems with reduced exercise tolerance may result in a deterioration of mood, which may initially manifest itself as anxiety and may progress, especially in vulnerable patients, to depression [3]. Sleepdisordered breathing, which is more common in patients with AF and poor sleep quality, appears to be an important risk factor for atrial fibrillation, and fatigue, mood disorders, which is associated with the severity of disease symptoms and the quality of life [4,5,6]

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