Association Between Sleep Disturbance And Severity Of Coronary Artery Lesions In Patients With Suspected Coronary Artery Disease

ObjectiveTo investigate the relationship between sleep disturbance and severity of coronary artery lesions in patients with suspected coronary heart disease.Further explore whether sleep disturbance was risk factor for coronary artery disease.MethodsA total of 499 patients admitted to Tianjin Chest Hospital from 2018 to 2019 were enrolled.In order to control mixed interence from anxiety and depression,patients with anxiety or depression were excluded.Finally 432 patients(age range 34～82 years;61.57% men)were included in the statistical analysis.They were subdivided into CAD group and non-CAD group according to the result of coronary angiography(CAG).In CAD group,the degrees of coronary artery lesions was divided into single-vessel disease、double-vessel disease and triple-vessel disease according to the number of vessel disease,and divided into≤30,30-60 and >60according to coronary gensini score.Pittsburgh sleep quality index was used to evalute sleep problems.Two groups were defined:sleep disturbance(PSQI > 7,n=130)and non-sleep disturbance(PSQI≤7,n=302).Binary logistic regression was used to analyze the relationship between sleep disturbance and coronary artery disease.Result1.The relationship between sleep disturbance and coronary artery disease(1)Baseline characteristics between sleep disturbance group and non-sleep disturbance group shown that frequency of male gender,left Ventricular end diastolic diameterlevel(LVEDD)were significantly lower in sleep disturbance group than in non-sleep disturbance group(P<0.05).(2)Considering the difference of sleep disturbance among different genders,next to investigate the relationship between sleep disturbance and coronary artery disease among different genders.In female,frequency of coronary artery disease was significantly higher in sleep disturbance group than in non-sleep disturbance group(P<0.05),however the relationship was not found in male(P>0.05).(3)The comparison of baseline data between CAD group and non-CAD group infemale.Frequency of age,smoking,systolic blood pressure,hcy,hypertension and sleep disturbance were significantly higher in CAD group than in non-CAD group(All P<0.05).(4)The comparison of baseline data between sleep disturbance group and nonsleep disturbance group in female.Frequency of physical activity was significantly lower in sleep disturbance group than in non-sleep disturbance group,SBP、DM、CAD were significantly higher in sleep disturbance group than in non-sleep disturbance group(All p<0.05).(5)Adjusting for age,smoking,history of hypertension and diabetes mellitus,BMI,TC,TG,LDL-C,HDL-C and homocysteine,binary logistic regression analysis showed that sleep disturbance is an independent risk factor for coronary heart disease in female(OR=2.717;95%CI:1.183～6.244;P<0.05).2.The relationship between sleep disturbance and degree of coronary artery lesions(1)Pearson correlation analysis of PSQI score and Gensini score:The interrelations between PSQI score and Gensini score were not statistically significant(All p>0.05).(2)In female patients with coronary artery disaese,compare the correlation between sleep disturbance and the degree of coronary artey disease.The result show that no correlation was observed between two groups whether the number of vessel disease or coronary Gensini score(All p>0.05).3.The relationship between seven sleep subgroups in PSQI and coronary artery disease and its risk factors(1)The comparison of seven sleep subgroups between CAD group and nonCAD group.We found that there were no differences in sleep subgroups between the two groups in all subjects(p > 0.05).In deferent gender,we found sleep quality score and sleep efficiency score were significant difference between the two groups in female(p<0.05),but there were no differences in sleep subgroups between the two groups in male(p>0.05).(2)Correlation analysis of seven sleep subgroups with coronary artery disease and its risk factors in female : correlation analysis of seven sleep subgroups withcoronary artery disease:positive correlations were found between sleep quality score、sleep efficiency score and coronary artery disease(p < 0.05).Association of seven sleep subgroups with coronary artery disease risk factors in female :(1)positive correlations were found between sleep quality score and DM,(2)positive correlations were found between fall asleep time score and hypertension,(3)positive correlations were found between sleep duration score and TG;(4)positive correlations were found between sleep efficiency score and age、SBP、DM(All p<0.05).Conclusion1.There are gender differences in the relationship between sleep disturbance and CAD.Sleep disturbance is an independent risk factor for CAD in female,but not in male.It is suggested that improving sleep problems may reduce the risk of CAD in female.And it provides a new basis for the prevention of CAD in clinic.2.Sleep quality and sleep efficiency have a greater influence on CAD in female,they can be regard as new targets for the prevention and treatment of CAD.3.In female,sleep quality、sleep efficiency、sleep duration and fall asleep time are associated with coronary artery disease risk factors,such as TG 、 DM and hypertension.