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Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction
BACKGROUND: Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249741/ https://www.ncbi.nlm.nih.gov/pubmed/30463526 http://dx.doi.org/10.1186/s12872-018-0947-5 |
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author | von Känel, Roland Princip, Mary Schmid, Jean-Paul Barth, Jürgen Znoj, Hansjörg Schnyder, Ulrich Meister-Langraf, Rebecca E. |
author_facet | von Känel, Roland Princip, Mary Schmid, Jean-Paul Barth, Jürgen Znoj, Hansjörg Schnyder, Ulrich Meister-Langraf, Rebecca E. |
author_sort | von Känel, Roland |
collection | PubMed |
description | BACKGROUND: Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of OSA as well as insomnia symptoms are associated with neuroendocrine hormones and coagulation factors in patients admitted with acute myocardial infarction. METHODS: We assessed 190 patients (mean age 60 years, 83% men) in terms of OSA risk (STOP screening tool for the assessment of high vs. low OSA risk) and severity of insomnia symptoms (Jenkins Sleep Scale for the assessment of subjective sleep difficulties) within 48 h of an acute coronary intervention. Circulating concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured the next morning. The association of OSA risk and insomnia symptoms with neuroendocrine hormones and coagulation factors was computed using multivariate models adjusting for demographic factors, health behaviors, somatic and psychiatric comorbidities, cardiac disease-related variables, and OSA risk in the model for insomnia symptoms, respectively, for insomnia symptoms in the model for OSA risk. RESULTS: High OSA risk was identified in 41% of patients and clinically relevant insomnia symptoms were reported by 27% of patients. Compared to those with low OSA risk, patients with high OSA risk had lower levels of epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001). More severe insomnia symptoms were associated with higher levels of fibrinogen (p = 0.037), driven by difficulties initiating sleep, and with lower levels of norepinephrine (p = 0.024), driven by difficulties maintaining sleep. CONCLUSIONS: In patients with acute myocardial infarction, sleep problems are associated with neuroendocrine hormones and coagulation activity. The pattern of these relationships is not uniform for patients with a high risk of OSA and those with insomnia symptoms, and whether they contribute to adverse cardiovascular outcomes needs to be established. TRIAL REGISTRATION: ClinicalTrials.gov NCT01781247. |
format | Online Article Text |
id | pubmed-6249741 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62497412018-11-26 Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction von Känel, Roland Princip, Mary Schmid, Jean-Paul Barth, Jürgen Znoj, Hansjörg Schnyder, Ulrich Meister-Langraf, Rebecca E. BMC Cardiovasc Disord Research Article BACKGROUND: Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of OSA as well as insomnia symptoms are associated with neuroendocrine hormones and coagulation factors in patients admitted with acute myocardial infarction. METHODS: We assessed 190 patients (mean age 60 years, 83% men) in terms of OSA risk (STOP screening tool for the assessment of high vs. low OSA risk) and severity of insomnia symptoms (Jenkins Sleep Scale for the assessment of subjective sleep difficulties) within 48 h of an acute coronary intervention. Circulating concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured the next morning. The association of OSA risk and insomnia symptoms with neuroendocrine hormones and coagulation factors was computed using multivariate models adjusting for demographic factors, health behaviors, somatic and psychiatric comorbidities, cardiac disease-related variables, and OSA risk in the model for insomnia symptoms, respectively, for insomnia symptoms in the model for OSA risk. RESULTS: High OSA risk was identified in 41% of patients and clinically relevant insomnia symptoms were reported by 27% of patients. Compared to those with low OSA risk, patients with high OSA risk had lower levels of epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001). More severe insomnia symptoms were associated with higher levels of fibrinogen (p = 0.037), driven by difficulties initiating sleep, and with lower levels of norepinephrine (p = 0.024), driven by difficulties maintaining sleep. CONCLUSIONS: In patients with acute myocardial infarction, sleep problems are associated with neuroendocrine hormones and coagulation activity. The pattern of these relationships is not uniform for patients with a high risk of OSA and those with insomnia symptoms, and whether they contribute to adverse cardiovascular outcomes needs to be established. TRIAL REGISTRATION: ClinicalTrials.gov NCT01781247. BioMed Central 2018-11-21 /pmc/articles/PMC6249741/ /pubmed/30463526 http://dx.doi.org/10.1186/s12872-018-0947-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article von Känel, Roland Princip, Mary Schmid, Jean-Paul Barth, Jürgen Znoj, Hansjörg Schnyder, Ulrich Meister-Langraf, Rebecca E. Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title | Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title_full | Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title_fullStr | Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title_full_unstemmed | Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title_short | Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
title_sort | association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249741/ https://www.ncbi.nlm.nih.gov/pubmed/30463526 http://dx.doi.org/10.1186/s12872-018-0947-5 |
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