Effects Of Sleep Quality And Sleep Quality Dimensions On Frailty In Elderly Patients With Coronary Heart Disease

Background:Coronary atherosclerotic heart disease,referred to as coronary heart disease（CHD）,is a common cardiovascular disease in the elderly.It has the characteristics of high incidence rate,easy to relapse,high hospitalization rate and high mortality in the elderly.Elderly patients with coronary heart disease are often accompanied by frailty.At present,it is mostly considered that frailty is a syndrome caused by multiple organs and systems damage,which eventually leads to the reduction of physiological reserves and the increase of vulnerability.It is the main cause of morbidity and mortality in the elderly.Previous studies have confirmed that frailty can not only increase the risk of cardiovascular disease in the elderly,but also be closely related to all-cause mortality,rehospitalization rate and the risk of major adverse cardiovascular events in elderly patients with CHD,which has an important impact on the prognosis.Existing studies have found that age,hypertension,smoking,diabetes,smoking,obesity,sedentary lifestyle,nutritional status,cognition,anxiety and depression can all affect the occurrence and development of frailty in elderly patients with CHD.Large numbers of studies have shown that the decline of sleep quality and the abnormality of sleep dimension are independent risk factors of frailty,which can not only increase the risk of frailty,but also lead to a series of clinical negative events related to frailty.The potential mechanism may be related to chronic inflammatory response,neuroendocrine and immune system disorders.With the increase of age,the physiological function of the elderly will gradually decline,and the sleep circadian rhythm and sleep structure will change,which will eventually lead to the decline of sleep quality and sleep disorders.At present,more than half of the elderly have reported that they have sleep problems,and patients with CHD are at high risk of poor sleep quality.Although studies about frailty have emerged one after another in recent years,there are few relevant clinical studies on the frailty of elderly patients with CHD,and there is no research to explore the specific impact of decline of sleep quality and each sleep quality dimension on frailty in elderly patients with CHD.Objective:By analyzing the specific impact of sleep quality and each sleep quality dimension on frailty in elderly patients with CHD,this study provides the basis for the accurate guidance and scheme formulation of healthy sleep behavior of elderly patients with CHD,and which is of great significance to the management of frailty and the improvement of prognosis of elderly patients with CHD.Methods:138 patients with CHD aged ≥ 60 years who were hospitalized in the Department of cardiovascular medicine of the second hospital of Jilin University from December 2020 to December 2021 were selected as the research objects.The general clinical data,relevant test indexes and frailty related functional manifestations of patients at admission were collected.The Chinese version of Edmonton Frail Scale（EFS）was used to evaluate the frailty of the patients.The patients were divided into non frailty group（EFS ≤ 5 points）and frailty group（EFS > 5 points）according to the EFS score.And the frailty group was divided into mild frailty group（EFS 6 ～ 7 points）,moderate frailty group（EFS 8 ～ 9 points）and severe frailty group（EFS ≥ 10 points）.Pittsburgh Quality Index（PSQI）was used to evaluate the sleep quality of patients.Those with PSQI ≤ 7 points were considered to have normal sleep quality,and those with PSQI > 7 points were considered to have poor sleep quality.The sleep quality assessed by PSQI can be divided into seven dimensions: self-reported sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance,use of sleeping pills and daytime function.Firstly,the patients included in the study were divided into frailty group and nonfrailty group,and the effects of sleep quality and sleep quality dimensions on the frailty of elderly patients with CHD were analyzed in turn.Then,we divided the patients into non frailty group,mild frailty group,moderate frailty group and severe frailty group,and gradually analyzed the impacts of sleep quality and sleep quality dimensions on the degree of frailty of elderly patients with CHD.Spss25.0 statistical software was used to analyze the data,and it was considered that P < 0.05 was statistically significant.Results:1.The incidence of frailty in elderly patients with CHD was 65.94%,and the incidence of mild frailty,moderate frailty and severe frailty were 28.99%,22.46% and 14.49%respectively;The incidence of poor sleep quality in elderly patients with CHD was46.38%.2.The correlation between the total score of EFS and the total score of PSQI in elderly patients with CHD was statistically different（r = 0.40,P < 0.001）;The incidence of poor sleep quality in non-frailty group was 25.53%,and that in frailty group was 57.14%,the difference was statistically significant（P < 0.001）;The median total score of PSQI in non-frailty group was 9.00（6.00）and that in frailty group was 5.00（5.00）,there was significant difference in the distribution of total score of PSQI between the two groups（P < 0.001）;The frailty of elderly patients with CHD was independently related to the decline of sleep quality（OR= 4.52,95% CI 1.66 ～ 12.34,P = 0.003）and the increase of total PSQI score（OR = 1.17,95% CI 1.03 ～ 1.32,P = 0.012）.3.There were significant differences in the correlation between the total score of EFS and self-reported sleep quality（r = 0.30,P < 0.001）、sleep latency（r = 0.34,P < 0.001）、sleep efficiency（r = 0.30,P < 0.001）、sleep disturbance（r = 0.31,P < 0.001）、using sleeping pills（r = 0.23,P = 0.007）and daytime dysfunction（r = 0.28,P = 0.001）in elderly patients with CHD;There were significant differences in the average scores of self-reported sleep quality,sleep latency,sleep efficiency,sleep disturbance,using sleeping pills and daytime dysfunction between the frailty group and the non-frailty group（P < 0.05）.4.The decline of sleep quality（OR= 1.72,95% CI 1.13 ～ 2.62,P = 0.012）and the increase of total PSQI score（OR = 1.09,95% CI 1.04 ～ 1.14,P = 0.001）in elderly patients with CHD were independently related to the aggravation of frailty.5.The increase of scores of sleep latency in elderly patients with CHD was independently correlated with the aggravation of frailty（OR = 1.43,95% CI 1.06 ～ 1.94,P = 0.020）.Conclusion:1.In elderly patients with CHD,the total score of EFS was positively correlated with the total score of PSQI;The decline of sleep quality is an independent factor for the increase of the risk of frailty and the aggravation of frailty;Compared with those with normal sleep quality,the risk of frailty increased by about 3.52 times,and the possibility of frailty aggravating at least one degree was 1.72 times in those with poor sleep quality;When the total score of PSQI increased by 1 point,the risk of frailty increased by about0.17 times,and the possibility of frailty aggravating at least one degree is 1.09 times.2.In elderly patients with CHD,the total score of EFS was positively correlated with the severity of self-reported sleep quality,sleep latency,sleep efficiency,sleep disturbance,using sleeping pills and daytime dysfunction;The increase of severity level of sleep latency is an independent factor to aggravate the frailty of elderly patients with CHD.When the severity of sleep latency increased one level,the possibility of frailty aggravating at least one degree is 1.43 times.