Alice Clark1, Theis Lange2, Johan Hallqvist3, Poul Jennum4, Naja Hulvej Rod1. 1. Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; The Copenhagen Stress Research Center, Copenhagen, Denmark. 2. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 3. Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden ; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. 4. Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
Abstract
STUDY OBJECTIVES: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). DESIGN: Prospective cohort study. SETTING: The Stockholm Heart Epidemiology Program, Sweden. PARTICIPANTS: There were 2,246 first-time AMI cases. MEASUREMENTS AND RESULTS: Sleep impairment was assessed by the Karolinska Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76-6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. CONCLUSION: Results suggest sex-specific effects of impaired sleep that differ by short- and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention.
STUDY OBJECTIVES:Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). DESIGN: Prospective cohort study. SETTING: The Stockholm Heart Epidemiology Program, Sweden. PARTICIPANTS: There were 2,246 first-time AMI cases. MEASUREMENTS AND RESULTS:Sleep impairment was assessed by the Karolinska Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76-6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. CONCLUSION: Results suggest sex-specific effects of impaired sleep that differ by short- and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention.
Authors: Fredrik Valham; Thomas Mooe; Terje Rabben; Hans Stenlund; Urban Wiklund; Karl A Franklin Journal: Circulation Date: 2008-08-12 Impact factor: 29.690
Authors: Michelle A Miller; Ngianga-Bakwin Kandala; Mika Kivimaki; Meena Kumari; Eric J Brunner; Gordon D O Lowe; Michael G Marmot; Francesco P Cappuccio Journal: Sleep Date: 2009-07 Impact factor: 5.849
Authors: Francesco P Cappuccio; Saverio Stranges; Ngianga-Bakwin Kandala; Michelle A Miller; Frances M Taggart; Meena Kumari; Jane E Ferrie; Martin J Shipley; Eric J Brunner; Michael G Marmot Journal: Hypertension Date: 2007-09-04 Impact factor: 10.190
Authors: Nasreen Alfaris; Thomas A Wadden; David B Sarwer; Lisa Diwald; Sheri Volger; Patricia Hong; Amber Baxely; Alyssa M Minnick; Marion L Vetter; Robert I Berkowitz; Jesse Chittams Journal: Obesity (Silver Spring) Date: 2015-01-22 Impact factor: 5.002
Authors: Anke R Hammerschlag; Sven Stringer; Christiaan A de Leeuw; Suzanne Sniekers; Erdogan Taskesen; Kyoko Watanabe; Tessa F Blanken; Kim Dekker; Bart H W Te Lindert; Rick Wassing; Ingileif Jonsdottir; Gudmar Thorleifsson; Hreinn Stefansson; Thorarinn Gislason; Klaus Berger; Barbara Schormair; Juergen Wellmann; Juliane Winkelmann; Kari Stefansson; Konrad Oexle; Eus J W Van Someren; Danielle Posthuma Journal: Nat Genet Date: 2017-06-12 Impact factor: 38.330
Authors: Kasra Moazzami; An Young; Samaah Sullivan; Jeong Hwan Kim; Mariana Garcia; Dayna A Johnson; Tené T Lewis; Amit J Shah; J Douglas Bremner; Arshed A Quyyumi; Viola Vaccarino Journal: Sleep Health Date: 2020-08-18