Kasra Moazzami1, An Young1, Samaah Sullivan2, Jeong Hwan Kim1, Mariana Garcia1, Dayna A Johnson2, Tené T Lewis2, Amit J Shah3, J Douglas Bremner4, Arshed A Quyyumi5, Viola Vaccarino6. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. 2. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia, USA. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Atlanta VA Medical Center, Decatur, Georgia, USA. 4. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; Atlanta VA Medical Center, Decatur, Georgia, USA. 5. Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. 6. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: viola.vaccarino@emory.edu.
Abstract
OBJECTIVE: To investigate differences in sleep quality by race in participants with and without a prior myocardial infarction (MI). DESIGN: Case-control study. SETTING: Emory-affiliated hospitals in Atlanta, Georgia. PARTICIPANTS: Two hundred seventy-three individuals (190 Black) ≤60 years of age with a verified MI in the previous 8 months, and 100 community controls (44 Black) without a history of MI. MEASUREMENTS: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Psychological factors were assessed using standardized questionnaires and clinical risk factors through medical history and chart review. RESULTS: A significant interaction existed between race and MI status on sleep quality (P= .01), such that Black individuals with a history of MI, but not controls, reported worse sleep quality than their non-Black counterparts. Among MI cases, being Black was independently associated with higher PSQI scores after adjusting for baseline demographics (B = 2.17, 95% confidence interval 1.17, 3.17, P = .006). Clinical risk factors, psychological factors and socioeconomic status (household income and years of education) all contributed equally to explain race-related disparities in sleep among MI cases. After further adjustment for these factors, the association was attenuated and no longer significant (B = 0.70, 95% confidence interval = -0.10, 1.21, P = .26). CONCLUSION: Black post-MI patients, but not healthy controls, have significantly poorer sleep quality than non-Blacks. This difference is driven by a combination of factors, including clinical risk factors, psychological factors as well as adverse socioeconomic conditions among Black individuals with MI.
OBJECTIVE: To investigate differences in sleep quality by race in participants with and without a prior myocardial infarction (MI). DESIGN: Case-control study. SETTING: Emory-affiliated hospitals in Atlanta, Georgia. PARTICIPANTS: Two hundred seventy-three individuals (190 Black) ≤60 years of age with a verified MI in the previous 8 months, and 100 community controls (44 Black) without a history of MI. MEASUREMENTS: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Psychological factors were assessed using standardized questionnaires and clinical risk factors through medical history and chart review. RESULTS: A significant interaction existed between race and MI status on sleep quality (P= .01), such that Black individuals with a history of MI, but not controls, reported worse sleep quality than their non-Black counterparts. Among MI cases, being Black was independently associated with higher PSQI scores after adjusting for baseline demographics (B = 2.17, 95% confidence interval 1.17, 3.17, P = .006). Clinical risk factors, psychological factors and socioeconomic status (household income and years of education) all contributed equally to explain race-related disparities in sleep among MI cases. After further adjustment for these factors, the association was attenuated and no longer significant (B = 0.70, 95% confidence interval = -0.10, 1.21, P = .26). CONCLUSION: Black post-MI patients, but not healthy controls, have significantly poorer sleep quality than non-Blacks. This difference is driven by a combination of factors, including clinical risk factors, psychological factors as well as adverse socioeconomic conditions among Black individuals with MI.
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