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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 102-104

Perceived sleep quality and quantity before acute myocardial infarction: A pilot study


Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India

Date of Submission31-Jul-2022
Date of Acceptance08-Aug-2022
Date of Web Publication19-Aug-2022

Correspondence Address:
H S Kiran
Department of General Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_43_22

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  Abstract 


Background: Sleep plays a vital role in disease prevention and rejuvenation. Diet and exercise are emphasized in the prevention of diseases, whereas sleep is often overlooked. The consequences of poor sleep often go unnoticed. Insufficient and poor sleep has been associated with various health problems and is considered an important risk factor. The objective of this study was to explore the association between perceived sleep quality and quantity before acute myocardial infarction (MI). Materials and Methods: It was a prospective observational study. Thirty hospitalized patients of acute coronary syndrome with an index event of first-time MI satisfying the inclusion and exclusion criteria were enrolled. The Pittsburgh Sleep Quality Index (PSQI) was administered to the patients. Other basic investigations done for the diagnosis and work-up of the cases by the treating doctors were noted and data were analyzed. Results: In our study, the mean Global PSQI score was 7.16 (standard deviation = 3.79). In our study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients with acute MI which was statistically significant (Spearman's Rho: r = 1) and “Good” (Global PSQI score <5) in 7 (23.3%) patients. All the patients >60 years of age had poor sleep quality. The average duration of sleep was 5 h 30 min. The majority of the patients (71%) with acute MI slept for <6 h which was statistically significant (Spearman's Rho: r = –1). Conclusion: This pilot study, based on PSQI, establishes the association between perceived sleep quality and quantity and acute MI.

Keywords: Myocardial infarction, sleep, sleep quality, sleep quantity


How to cite this article:
Kiran H S, Gowthami T. Perceived sleep quality and quantity before acute myocardial infarction: A pilot study. J Pract Cardiovasc Sci 2022;8:102-4

How to cite this URL:
Kiran H S, Gowthami T. Perceived sleep quality and quantity before acute myocardial infarction: A pilot study. J Pract Cardiovasc Sci [serial online] 2022 [cited 2022 Oct 3];8:102-4. Available from: https://www.j-pcs.org/text.asp?2022/8/2/102/354139




  Introduction Top


“Sleep that knits up the ravelled sleeve of care

The death of each day's life, sore labour's bath

Balm of hurt minds, great nature's second course,

Chief nourisher in life's feast.”

- William Shakespeare, Macbeth

The above quote highlights the importance of sleep. Diet and exercise are emphasized in the prevention of diseases, whereas sleep is often overlooked. The consequences of poor sleep often go unnoticed. Insufficient and poor sleep has been associated with various health problems and is considered an important risk factor.[1],[2],[3] Insufficient and poor sleep has been implicated in various cardiovascular and metabolic diseases vis-a-vis inflammatory mediators and hormones.[4],[5] However, studies looking into sleep quality and quantity before acute myocardial infarction (MI) are scanty.

The objective of this study was to explore the association between perceived sleep quality and quantity before acute MI in a cohort of hospitalized patients of acute coronary syndrome with an index event of first-time MI utilizing the Pittsburgh Sleep Quality Index (PSQI).[6]

The PSQI is a self-report questionnaire that assesses sleep quality over a 1-month time interval consisting of 19 individual items, creating seven components that produce one global score.[6] The PSQI is a standardized sleep questionnaire which is reliable and valid. PSQI has been utilized in various research and clinical settings.[6]


  Materials and Methods Top


It was a hospital-based observational study. Hospitalized patients of acute coronary syndrome with an index event of first-time MI were studied at a tertiary care teaching hospital attached to a medical college affiliated to a deemed university in South India.

Approval from the institutional ethics committee was taken. Inclusion criteria were patients above the age of 18 years; diagnosed to have acute MI as per standard guidelines (with an index event of first-time MI). Exclusion criteria were patients <18 years of age, patients with recurrent MI, unstable angina, and sleep disorders like OSA. It was a pilot study. The sample size was 30 (calculated using the software Epi Info for Windows version 7.2 https://www.cdc.gov/epiinfo/pc.html). Patients were selected by convenience sampling. Hospitalized patients of acute coronary syndrome with an index event of first-time MI satisfying the inclusion and exclusion criteria were enrolled and informed voluntary written consent was obtained from the patients. The clinical details were noted in a pretested pro forma. The PSQI was administered to the patients who were literate and able to read, understand, and fill the English version of the PSQI. Other basic investigations done for the diagnosis and work-up of the cases by the treating doctors were noted. The details were entered into Microsoft Excel software for windows and data were analyzed using SPSS Statistics for Windows, version 18. 0 (SPSS Inc., Chicago, Ill., USA).


  Results Top


The total number of patients was 30. Thirty hospitalized patients of acute coronary syndrome with an index event of first-time MI were studied. Twenty-two were males (73.3%) and 8 were females (26.7%). The mean age was 59.5 years (standard deviation [SD] = 10.7). Ten patients (33.3%) had no comorbidities while 10 (33.3%) patients had diabetes mellitus only, 3 (10%) patients had hypertension only and 7 (23.3%) patients had both diabetes mellitus and hypertension. The overall reliability coefficient alpha (Cronbach's alpha) for the PSQI was 0.75 which is satisfactory.

The PSQI is a self-report questionnaire that assesses sleep quality over a 1-month time interval consisting of 19 individual items, creating seven components that produce one global score.[6] The subjects rated each of the items. Scoring of the answers was based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the Likert scale. A global sum of “5” or greater indicates a “poor” sleeper.[6]

In our study, the mean Global PSQI score was 7.16 (SD = 3.79). In our study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients [Table 1] with acute MI which was statistically significant (Spearman's Rho: r = 1) and “Good” (Global PSQI score <5) in 7 (23.3%) patients [Figure 1]. Troponin I levels also correlated with “POOR” sleep quality (P = 0.01) [Table 2]. All the patients >60 years of age had poor sleep quality. The average duration of sleep was 5 h 30 min. The majority of the patients (71%) with acute MI slept for <6 h which was statistically significant (Spearman's Rho: r = –1).
Figure 1: Sleep quality in patients with acute MI. MI: Myocardial infarction.

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Table 1: Sleep quality “poor” (Global Pittsburgh Sleep Quality Index score >5) in 23 patients

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Table 2: Sleep quality correlated with troponin I levels

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  Discussion Top


“Sleep is the interest we have to pay on the capital which is called in at death; and the higher the rate of interest and the more regularly it is paid, the further the date of redemption is postponed.”

- Arthur Schopenhauer

Sleep plays a vital role in disease prevention and rejuvenation. It has been noticed that partial sleep deprivation for only 5 nights itself could result in endothelial dysfunction, impaired cardiovascular autonomic control, rise in sympathetic activity, and impaired blood pressure variability.[7] In a study, sleep duration >7 h in addition to lifestyle modifications such as physical activity, healthy diet, moderate use of alcohol, and no smoking had a decreased risk of cardiovascular disease (CVD).[8]

In our study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients with acute MI which was statistically significant. In a similar study by Andrechuk CRS, 71.7% of patients with acute MI had poor sleep quality based on the PSQI scores.[9]

In our study, the average duration of sleep was 5 h 30 min. The majority of the patients (71%) with acute MI slept for <6 h which was statistically significant. In the study by Andrechuk CRS, more than 64% slept 6 h or less per night.[9]

Studies indicate that reduction in the duration of sleep (less than 5 h and more than 9 h) are associated with an increased risk of developing and/or dying of coronary artery disease and AMI.[10],[11],[12],[13] Studies also demonstrate that <6 h of sleep per night,[14],[15] or <7½ h for diabetic patients is associated with an increased risk for acute MI.[16]

Sleep improves physical and mental health by its rejuvenating effect. Studies have established that poor sleep quality and quantity are risk factors for CVD, cardiac death, and all-cause mortality.[10],[17]

Poor sleep quality and quantity have been demonstrated as risk factors in various cardiovascular and metabolic diseases as a result of various inflammatory mediators and hormones.[4],[5] The association between sleep and development of diabetes mellitus has been elucidated by various studies. A study demonstrated that the duration of sleep of <6 h per night is associated with a 28% increased risk of developing diabetes.[18] Furthermore, an association between decreased sleep duration and sleep fragmentation with decreased glucose tolerance and insulin sensitivity has been found.[19],[20] While there are many studies on such associations, studies looking into sleep quality and quantity before acute MI are scanty. While this pilot study explores and establishes the association between perceived sleep quality and quantity and acute MI, the main limitations are its small sample size and its inability to adjust for other confounding factors. This study is one of the few studies undertaken in India. However, this study was based on self-reporting by the subjects which always carries a bias. Further studies with a larger sample size and other objective data with exploration of factors affecting sleep are desirable to evolve guidelines and recommendations.


  Conclusion Top


In this pilot study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients with acute MI and the majority of the patients (71%) with acute MI slept for <6 h, thus establishing the association between perceived sleep quality and quantity and acute MI.

Acknowledgment

We express our sincere & heartfelt gratitude to Dr. BasavanaGowdappa H, our Respected Principal and Dr. Sunil Kumar, HOD of Cardiology.

Ethics clearance

Taken from institutional ethics committee (JSSMC).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hernandez R, Vu TT, Kershaw KN, Boehm JK, Kubzansky LD, Carnethon M, et al. The association of optimism with sleep duration and quality: Findings from the coronary artery risk and development in young adults (CARDIA) study. Behav Med 2020;46:100-11.  Back to cited text no. 1
    
2.
Kim JS, Dashti HS, Huang T, Cade BE, Podolanczuk AJ, O'Hearn DJ, et al. Associations of sleep duration and sleep-wake rhythm with lung parenchymal abnormalities on computed tomography: The MESA study. J Sleep Res 2022;31:e13475.  Back to cited text no. 2
    
3.
Liew SC, Aung T. Sleep deprivation and its association with diseases – A review. Sleep Med 2021;77:192-204.  Back to cited text no. 3
    
4.
Kanagasabai T, Riddell MC, Ardern CI. Inflammation, oxidative stress, and antioxidant micronutrients as mediators of the relationship between sleep, insulin sensitivity, and glycosylated hemoglobin. Front Public Health 2022;10:888331.  Back to cited text no. 4
    
5.
Liu H, Chen A. Roles of sleep deprivation in cardiovascular dysfunctions. Life Sci 2019;219:231-7.  Back to cited text no. 5
    
6.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, and Kupfer DJ. The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research 1989;28:193-213.  Back to cited text no. 6
    
7.
Dettoni JL, Consolim-Colombo FM, Drager LF, Rubira MC, Souza SB, Irigoyen MC, et al. Cardiovascular effects of partial sleep deprivation in healthy volunteers. J Appl Physiol (1985) 2012;113:232-6.  Back to cited text no. 7
    
8.
Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, Verschuren WM. Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: The MORGEN study. Eur J Prev Cardiol 2014;21:1367-75.  Back to cited text no. 8
    
9.
Andrechuk CR, Ceolim MF. Sleep quality in patients with acute myocardial infarction. Texto Contexto Enferm 2015;24:1104-11.  Back to cited text no. 9
    
10.
Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. Eur Heart J 2011;32:1484-92.  Back to cited text no. 10
    
11.
Magee CA, Kritharides L, Attia J, McElduff P, Banks E. Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults. J Sleep Res 2012;21:441-7.  Back to cited text no. 11
    
12.
Xiao Q, Keadle SK, Hollenbeck AR, Matthews CE. Sleep duration and total and cause-specific mortality in a large US cohort: Interrelationships with physical activity, sedentary behavior, and body mass index. Am J Epidemiol 2014;180:997-1006.  Back to cited text no. 12
    
13.
Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: Results from the national health interview survey. Sleep 2010;33:1037-42.  Back to cited text no. 13
    
14.
Hung HC, Yang YC, Ou HY, Wu JS, Lu FH, Chang CJ. The association between self-reported sleep quality and overweight in a Chinese population. Obesity (Silver Spring) 2013;21:486-92.  Back to cited text no. 14
    
15.
Aggarwal S, Loomba RS, Arora RR, Molnar J. Associations between sleep duration and prevalence of cardiovascular events. Clin Cardiol 2013;36:671-6.  Back to cited text no. 15
    
16.
Eguchi K, Hoshide S, Ishikawa S, Shimada K, Kario K. Short sleep duration and type 2 diabetes enhance the risk of cardiovascular events in hypertensive patients. Diabetes Res Clin Pract 2012;98:518-23.  Back to cited text no. 16
    
17.
Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF. Insomnia and risk of cardiovascular disease: A meta-analysis. Eur J Prev Cardiol 2014;21:57-64.  Back to cited text no. 17
    
18.
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2010;33:414-20.  Back to cited text no. 18
    
19.
Stamatakis KA, Punjabi NM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 2010;137:95-101.  Back to cited text no. 19
    
20.
Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes 2010;59:2126-33.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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