Relationship Between Sleep Duration and Coronary Artery Disease in Older Adults

Year 2023, , 198 - 204, 07.08.2023

Pelin Ünsal , Mert Eşme , Cafer Balcı , Gözde Şengül Ayçiçek , Burcu Balam Yavuz , Meltem Halil , Mustafa Cankurtaran

https://doi.org/10.46332/aemj.1159731

Abstract

Purpose: Insomnia, a frequent geriatric syndrome, is thought to be linked with coronary artery disease and increased mortality. The aim of our study was to examine the relationship between sleep duration and coronary artery disease (CAD) and cardiovascular risk factors.

Materials and Methods: In this study, patients who applied to the geriatric outpatient clinic for comprehensive geriatric assessment were retrospectively evaluated. Patients were divided into two groups according to the six hours of ideal sleep assumption: those who slept less than six hours and those who slept six hours or more.

Results: A total of 2255 patients (age 72±6 years, 63.3% female) were included in this study. Patients who were sleeping less than 6 hours were older (14.4% vs. 10.3%; p=0.005) and most of them were female (69.5% vs. 60.2%; p<001). Coronary artery disease (31.9% vs. 25.9%; p= 0.003), falls (31.8% vs. 25.3%; p=0.002) and depression (25.7% vs. 21.3%; p=0.022) were more common, while hypertension ( 68.5% and 72.5%; p=0.049) were less common in the short sleep duration group. The regression analysis showed that short sleep duration was significantly associated with CAD (OR:1.39; 95% CI:1.14-1.7; p=0.001), falls history (OR:1.25; 95% CI:1.02-1.5; p=0.026), age (OR:1.01; 95% CI:1.01-1.04; p=0.001), male gender (OR:0.63; 95% CI:0.51-0.76; p<0.001), and hypertension (OR:0.74; %95 CI:0.6-0.9; p=0.003).

Conclusion: Similar to the literature, CAD was observed more frequently in patients who slept less than 6 hours in our results. Considering this relationship between short sleep duration and CAD, it is important to question sleep duration in comprehensive geriatric assessment.

Keywords

insomnia, geriatrics, cardiovascular disease, sleep disorders

Yaşlı Hastalarda Uyku Süresi ile Koroner Arter Hastalığı İlişkisi

Abstract

Amaç: Sık görülen bir geriatrik sendrom olan uykusuzluğun koroner arter hastalığı ve mortalitede artış ile ilişkili olduğu düşünülmektedir. Çalışmanın amacı, uyku süresi ile koroner arter hastalığı (KAH) ve kardiyovasküler risk faktörleri arasındaki ilişkiyi incelemektir.

Araçlar ve Yöntem: Bu çalışmada, geriatri polikliniğine başvuran ve kapsamlı geriatrik değerlendirmesi yapılan hastalar retrospektif olarak incelendi. Optimal uyku süresi altı saat olarak kabul edildi ve hastalar 6 saatten az uyuyan ve 6 saatten fazla uyuyan olmak üzere iki gruba ayrıldı.

Bulgular: Çalışmaya toplam 2255 hasta dahil edildi. Hastaların %63.3’ü kadın, yaş ortalaması 72±6’idi. 6 saatten kısa uyku süresi olan hasta grubu daha yaşlı (%14.4 ve %10.3 p=0.005) ve kadın (%69.5 ve %60.2 p<0.001) oranı daha fazlaydı. Kısa uyku süresi grubunda koroner arter hastalığı (%31.9 ve %25.9; p= 0.003), düşme (%31.8 ve %25.3; p=0.002) ve depresyon (%25.7% ve %21.3; p=0.022) daha sık görülürken, hipertansiyon (%68.5 ve %72.5; p=0.049) daha az görülmekteydi. Yapılan regresyon analizinde koroner arter hastalığı [OR=1.39, %95 CI:1.14-1.7; p=0.001], düşme [OR=1.25, %95 CI:1.02-1.5; p=0.026], yaş [OR=1.01, %95 CI:1.01-1.04; p=0.001], erkek cinsiyet [OR=0.63, %95 CI:0.51-0.76; p<0.001] ve hipertansiyon [OR=0.74, %95 CI:0.6-0.9; p=0.003] diğer tüm parametrik değerlerden bağımsız olarak altı saatten az uyuma ile ilişkili bulundu.

Sonuç: Çalışma bulguları, literatüre benzer şekilde 6 saatten az uyuyan hastalarda KAH daha sık gözlenmiştir. Kısa uyku süresi ile KAH arasındaki bu ilişki göz önüne alındığında, kapsamlı geriatrik değerlendirmede uyku süresinin sorgulanması önemli olduğu anlaşılmaktadır.

Keywords

insomnia, geriatri, kardiyovasküler hastalık, uyku bozuklukları

References

• 1. Suzuki K, Miyamoto M, Hirata K. Sleep disorders in the elderly: Diagnosis and management. J Gen Fam Med. 2017;18(2):61-71.
• 2. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004;27(7):1255-1273.
• 3. Benbir G, Demir AU, Aksu M, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry Clin. Neurosci. 2015;69(9):543-552.
• 4. Stone KL, Ewing SK, Ancoli-Israel S, et al. Self-reported sleep and nap habits and risk of mortality in a large cohort of older women. J Am Geriatr Soc. 2009;57(4):604-611.
• 5. Amagai Y, Ishikawa S, Gotoh T, et al. Sleep duration and mortality in Japan: the Jichi Medical School Cohort Study. J Epidemiol. 2004;14(4):124-128.
• 6. Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J. Intern. Med. 2002;251(3):207-216.
• 7. 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(12):1484-1492.
• 8. Holliday EG, Magee CA, Kritharides L, Banks E, Attia J. Short sleep duration is associated with risk of future diabetes but not cardiovascular disease: a prospective study and meta-analysis. PloS one. 2013;8(11):e82305.
• 9. Tobaldini E, Costantino G, Solbiati M, et al. Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases. Neurosci Biobehav Rev. 2017;74:321-329.
• 10. Khan MS, Aouad R. The Effects of Insomnia and Sleep Loss on Cardiovascular Disease. Sleep Med Clin. 2017;12(2):167-177.
• 11. Cappuccio FP, Miller MA. Are Short Bad Sleep Nights a Hindrance to a Healthy Heart? Sleep. 2011;34(11):1457-1458.
• 12. Yazdanpanah MH, Homayounfar R, Khademi A, Zarei F, Shahidi A, Farjam M. Short sleep is associated with higher prevalence and increased predicted risk of cardiovascular diseases in an Iranian population: Fasa PERSIAN Cohort Study. Scientific Reports. 2020;10(1):4608.
• 13. Gülgen C ET, Eker E, Yaşar R, Engin F. Standardize Mini Mental Test'in Türk toplumunda hafif demans tanısında geçerlilik ve güvenirliği. Turk Psikiyatri Derg. 2002;13(4):273-281.
• 14. Ertan T, Bugay G, Eker E. Geriatrik depresyon ölçeği kısa versiyonlarının Türk yaşlı toplumunda geçerlilik ve güvenirliliği: GDS-15, GDS-10, GDS-4. presented at: Ulusal Geropsikiyatri Sempozyumu; Haziran 10-12, 2004;İstanbul.
• 15. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
• 16. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep health. 2015;1(1):40-43.
• 17. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675-700.
• 18. Zhu G, Catt M, Cassidy S, et al. Objective sleep assessment in >80,000 UK mid-life adults: Associations with sociodemographic characteristics, physical activity and caffeine. PloS one. 2019;14(12):e0226220.
• 19. Wang Q, Wang X, Yang C, Wang L. The role of sleep disorders in cardiovascular diseases: Culprit or accomplice? Life sciences. 2021;283:119851.
• 20. Yin J, Jin X, Shan Z, et al. Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2017;6(9):e005947.
• 21. Kwok CS, Kontopantelis E, Kuligowski G, et al. Self-Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose-Response Meta-Analysis. J Am Heart Assoc. 2018;7(15):e008552.
• 22. Huang B-H, Duncan MJ, Cistulli PA, Nassar N, Hamer M, Stamatakis E. Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk. Br J Sports Med. 2022;56(13):718-724.
• 23. Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009;32(4):491-497.
• 24. Lunyera J, Park YM, Ward JB, et al. A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study. J Hypertens. 2021;39(11): 2210-2219.
• 25. Hu Y, Yan Z, Fu Z, Pan C. Associations of Insomnia With Hypertension and Coronary Artery Disease Among Patients With Type 2 Diabetes Mellitus. Front. Cardiovasc. Med. 2021;8:730654.
• 26. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337.
• 27. Hall MH, Smagula SF, Boudreau RM, et al. Association between sleep duration and mortality is mediated by markers of inflammation and health in older adults: the Health, Aging and Body Composition Study. Sleep. 2015;38(2):189-195.
• 28. Liu H, Li D, Zhao X, Fang B, Zhang Q, Li T. Longitudinal Impact of Frailty States and Sleep Duration on Subsequent Depressive Symptoms of Older Adults. J Am Geriatr Soc. 2021;69(4):1003-1011.
• 29. Dasdemir Ilkhan G, Celikhisar H. The effect of incontinence on sleep quality in the elderly. Int. J. Clin. Pract. 2021;75(5):e13965.
• 30. Nazaripanah NS, Momtaz YA, Mokhtari F, Sahaf R. Urinary incontinence and sleep complaints in community dwelling older adults. Sleep Sci. 2018;11(2):106-111.
• 31. Wu L, Sun D. Sleep duration and falls: a systemic review and meta-analysis of observational studies. J Sleep Res. 2017;26(3):293-301.
• 32. Unsal P, Sengul Aycicek G, Deniz O, et al. Insomnia and falls in older adults: are they linked to executive dysfunction? Psychogeriatrics : the official journal of the Japanese. Int. Psychogeriatr. 2021;21(3):359-367.
• 33. Mc Carthy CE. Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person. Med Sci (Basel). 2021;9(2):31.