Nearly half of patients with heart disease suffer from insomnia, according to a recent study. The results of the study have been published in the journal “Sleep Advances”.
“Sleep problems are linked to mental health problems, but our study found that insomnia was still significantly associated with cardiac events, even after controlling for symptoms of anxiety and depression,” said lead author Lars Frojd, a medical student at the University of Oslo, Norway. . “The results suggest that cardiac patients should be evaluated for insomnia and provided with appropriate management,” she added.
The prospective study included 1,068 consecutive patients on average 16 months after a heart attack and/or a procedure to open clogged arteries (stent implantation or bypass). Data on insomnia, risk factors for repeated cardiac events, and coexisting conditions were collected at baseline. Participants completed the Bergen Insomnia Scale questionnaire which is based on the diagnostic criteria for insomnia.3 Six questions relate to the ability to fall asleep and stay asleep, waking up prematurely, feeling inadequate rested, fatigue during the day that affects the ability to function at work or socially, and being dissatisfied with sleep.
Risk factors included C-reactive protein (a marker of inflammation), smoking status, low-density lipoprotein (LDL) cholesterol, diabetes, physical activity, waist circumference and blood pressure systolic. Coexisting conditions were stroke, transient ischemic attack, peripheral arterial disease and renal failure. Patients were followed for the primary composite endpoint of major adverse cardiovascular events (MACE), defined as cardiovascular death, hospitalization due to myocardial infarction, revascularization, stroke, or heart failure. Outcome data were obtained from hospital records.
About one in five participants (21%) was a woman. At baseline, the average patient age was 62, almost half (45%) suffered from insomnia, and 24% had used sleeping pills in the previous week. During a mean follow-up of 4.2 years, a total of 364 MACEs occurred in 225 patients. Compared to those without insomnia, the relative risk of recurrent MACE in patients with insomnia was 1.62 after adjusting for age and gender, 1.49 after further adjustment for coronary risk factors, and 1. .48 after also adjusting for coexisting conditions.
The association between insomnia and recurrent MACE remained significant when symptoms of anxiety and depression were also adjusted, with a relative risk of 1.41. Insomnia accounted for 16% of recurrent MACE in attributable risk fraction analyses, ranking third after smoking (27%) and low physical activity (21%).
Mr Frojd said: “This means that 16% of recurrent major adverse cardiovascular events could have been avoided if none of the participants had insomnia.” He concluded: “Our study indicates that insomnia is common in patients with heart disease and is linked to later cardiovascular problems, regardless of risk factors, coexisting health conditions and mental health symptoms. Further research is needed to determine if insomnia treatments such as behavioral therapy and digital applications are effective in this patient group.” (ANI)
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