Nighttime heart rate and survival in depressed patients post acute myocardial infarction.
Nighttime heart rate and survival in depressed patients post acute myocardial infarction.
复制标题
DOI：
10.1097/psy.0b013e3181835ca3
复制
发表时间：
2008-09
影响因子：
3.3
通讯作者：
Jaffe AS
中科院分区：
文献类型：
--
作者：
Carney RM;Steinmeyer B;Freedland KE;Blumenthal JA;Stein PK;Steinhoff WA;Howells WB;Berkman LF;Watkins LL;Czajkowski SM;Domitrovich PP;Burg MM;Hayano J;Jaffe AS
抑郁是急性心肌梗死（AMI）后死亡的危险因素。它还与睡眠障碍和心率（HR）升高有关，这可能在夜间更明显。已发现静息和24小时HR可预测患者和社区样本的死亡率。本研究的目的是确定：1）近期发生AMI的抑郁患者夜间HR是否高于非抑郁患者，2）夜间HR升高是否与AMI后生存率降低相关。动态心电图数据来自333名抑郁症和383名非抑郁症近期AMI患者。随访时间长达30个月（中位数= 24）。与非抑郁症患者相比，抑郁症患者的夜间HR（70.7 ± 0.7次/分vs 67.7 ± 0.6次/分; p= 0.001）和日间HR（76.4 ± 0.7次/分vs 74.2 ± 0.6次/分; p= 0.02）更高，即使在调整了潜在的混淆因素之后。抑郁症（H.R. = 2.19; p=.02）和夜间（H.R. = 1.03; p= 0.004），但不是白天HR，预测生存后，调整其他主要预测因子和相互。AMI后抑郁患者的平均日间和夜间HR均高于非抑郁患者，抑郁和夜间HR均是这些患者死亡率的独立预测因子。虽然抑郁症患者的夜间HR高于非抑郁症患者，但夜间HR升高可预测死亡率，与抑郁状态无关。
Depression is a risk factor for mortality following acute myocardial infarction (AMI). It is also associated with sleep disturbances, and with elevated heart rate (HR), which may be more pronounced at night. Resting and 24 hour HR have been found to predict mortality in patient and community samples. The purpose of this study was to determine: 1) whether depressed patients with a recent AMI have higher nighttime HR than nondepressed patients, and 2) whether elevated nighttime HR is associated with decreased survival following AMI. Ambulatory ECG data were obtained from 333 depressed and 383 nondepressed patients with a recent AMI. They were followed for up to 30 (median = 24) months. Depressed patients had higher nighttime (70.7 ∀ .7 versus 67.7 ∀ .6 bpm; p=.001), and daytime (76.4 ∀.7 versus 74.2 ∀ .6 bpm; p=.02) HR than nondepressed patients, even after adjusting for potential confounds. Depression (H.R. = 2.19; p=.02) and nighttime (H.R. = 1.03; p=.004), but not daytime HR, predicted survival after adjusting for other major predictors and for each other. Mean day and nighttime HRs are higher in depressed than in nondepressed patients following an AMI, and both depression and nighttime HR are independent predictors of mortality in these patients. Although depressed patients have a higher nighttime HR than nondepressed patients, elevated nighttime HR predicts mortality independent of depression status.