Clinical Correlates of Insomnia in Patients With Acute Coronary Syndrome
Clinical Correlates of Insomnia in Patients With Acute Coronary Syndrome
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DOI：
10.1536/ihj.54.258
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发表时间：
2013-09-01
影响因子：
1.5
通讯作者：
Smith, Michael T.
中科院分区：
文献类型：
--
作者：
Coryell, Virginia T.;Ziegelstein, Roy C.;Smith, Michael T.
本研究旨在探讨急性冠脉综合征（ACS）患者失眠的患病率及其与抑郁、焦虑和合并症的关系。失眠增加ACS患者复发性心脏事件的风险，但对这种情况下失眠的患病率和临床相关性知之甚少。在城市学术医疗中心因ACS入院的患者（n = 102, 58.3 +/- 10.6岁）完成了失眠严重程度指数、Epworth嗜睡量表以及抑郁和焦虑的测量。一个子集（n = 20）在出院几周后在家中完成了动态多导睡眠图（PSG）。37%的患者在住院期间报告有中度或重度失眠症，并且通过家庭PSG测量睡眠开始后的清醒时间增加了76分钟。虽然抑郁和失眠密切相关，但大约四分之一的失眠患者没有明显的抑郁症状。80%的PSG患者有睡眠呼吸暂停记录，但失眠与睡眠呼吸暂停、周期性肢体运动、人口统计学因素或肝脏疾病以外的医疗状况无关。超过三分之一的ACS患者在住院期间存在失眠，但高危患者无法通过人口统计学或医学因素或抑郁症状轻易识别。
This study sought to examine the prevalence of insomnia and its association with depression, anxiety, and medical comorbidities in patients after an acute coronary syndrome (ACS). Insomnia increases risk of recurrent cardiac events in ACS patients, but little is known about the prevalence and clinical correlates of insomnia in this setting. Patients (n = 102, 58.3 +/- 10.6 years-old) admitted for ACS to a cardiology service at an urban academic medical center completed the Insomnia Severity Index, Epworth Sleepiness Scale, and measures of depression and anxiety. A subset (n = 20) completed ambulatory polysomnography (PSG) in their homes several weeks after discharge. Moderate or severe insomnia was reported by 37% of patients during hospitalization and was associated with 76 minutes more wake after sleep onset measured by home PSG. Although depression and insomnia were strongly associated, about 1 in 4 patients with insomnia did not report significant depressive symptoms. Sleep apnea was documented in 80% of patients on PSG, but insomnia was not associated with sleep apnea, periodic limb movements, demographic factors, or medical conditions other than liver disease. Insomnia is present in over one-third of ACS patients during hospitalization, but at-risk patients could not be readily identified by demographic or medical factors or by depression symptoms.