The Study Of Association Between Sleep Health And Short-term Prognosis In Patients With Acute Coronary Syndrome

Objective:The short-term prognosis of individuals with acute coronary syndrome(ACS)is poor;hence the identification of modifiable risk factors is crucial.Sleep is a modifiable behavioral factor intricately linked to cardiovascular well-being,encompassing various dimensions such as sleep duration,timing,efficiency,satisfaction,and daytime sleepiness.Nevertheless,its impact on the short-term prognosis of ACS patients is ambiguous.To address this,we conducted a prospective study investigating the correlation between multidimensional sleep health and the short-term prognosis of individuals with ACS.Methods:Between January 2022 and October 2022,patients experiencing acute coronary syndrome(ACS)for the first time were continuously enrolled in this study.General information and clinical data were collected,while the Seattle Angina Scale(Seattle Angina Questionnaire,SAQ)scores were used for the baseline survey.Furthermore,the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to gather information on five dimensions of patients’sleep,namely duration,timing,satisfaction,efficiency,and daytime sleepiness.A comprehensive sleep health score was established,with a range of scores from 0 to 5,and patients were categorized into three groups based on their scores.Three sleep health groups,namely high(4-5),medium(2-3),and low(0-1),were followed up for 90 days to collect SAQ scores,frequency of angina pectoris,and occurrence of Major Adverse Cardiovascular Events(MACE).A total of 656 patients with ACS completed the follow-up.Ordinal logistic regression was utilized to analyze the relationship between sleep health and the frequency of angina pectoris,while COX regression was used to investigate the relationship between sleep health and the risk of MACE events.Results:(1)A total of 735 questionnaires were distributed,696 were recovered,and 40 cases were lost during follow-up.The study comprised 656 patients diagnosed with ACS,out of which144(21.95%),304(46.34%),and 208(31.71%)belonged to the low,medium,and high sleep health cohorts,respectively.The low sleep health group displayed a greater BMI,elevated Hb A1c,LDL,TG,TC,and UA levels,a larger percentage of individuals with anxiety and depression,a higher Gensini score,and a greater number of coronary arteries involved.Additionally,a considerable number of patients required PCI treatment(P<0.05);(2)Compared to the baseline level,the SAQ scores of every dimension in ACS patients 90days after discharge significantly improved(P<0.05).However,as the level of sleep health decreased,there was a significant improvement in the degree of physical activity limitation,stable state of angina pectoris,angina pectoris attack,and disease recognition(P<0.05).Additionally,the cognitive degree score showed a downward trend in the improvement score(P<0.05),while the change in the treatment satisfaction score among the groups did not exhibit any statistically significant difference;(3)The proportions of daily angina pectoris out-of-hospital 90-day in the low,medium and high sleep health groups were 12.50%,10.86%,and 8.17%,respectively.Univariate logistic regression analysis showed that compared with high sleep fitness,low sleep fitness(OR=2.18,95%CI:1.44-3.30)was associated with higher 90-day out-of-hospital angina frequency,and after adjusted for covariates.Low sleep fitness(OR=1.66,95%CI:1.05-2.63)was still associated with higher frequency of angina adjusted for covariates;(4)A total of 65 cases of MACE occurred within 90 days of follow-up,mainly including heart failure(58.46%),re-admission or emergency treatment due to unstable angina(32.31%),and non-fatal myocardial infarction(9.23%).Univariate COX regression analysis showed that,compared with high sleep fitness,low sleep fitness was associated with an increased risk of MACE within 90 days after being out of hospital(HR=3.39,95%CI:1.66-6.91).Low sleep fitness was still associated with MACE(HR=2.24,95%CI:1.03-4.88)adjusted for covariates;(5)The Kaplan-Meier analysis revealed that individuals categorized under the lower sleep fitness group had an escalated cumulative hazard of MACE,in comparison to those in the high sleep fitness group(log Rank testX~2=12.71,P=0.002).Conclusion:(1)Grouped by comprehensive sleep health score,ACS patients with lower sleep health had less improvement in out-of-hospital 90-day SAQ scores;(2)Low sleep fitness associated with higher 90-day out-of-hospital angina frequency in ACS patients;(3)Low sleep fitness is associated with increased risk of MACE within 90 days of out-of-hospital ACS patients.