Coryell Virginia T, Ziegelstein Roy C, Hirt Kellie, Quain Angela, Marine Joseph E, Smith Michael T
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
Int Heart J. 2013;54(5):258-65. doi: 10.1536/ihj.54.258.
This study sought to examine the prevalence of insomnia and its association with depression, anxiety, and medical comorbidities in patients after an acute coronary syndrome (ACS). Insomnia increases risk of recurrent cardiac events in ACS patients, but little is known about the prevalence and clinical correlates of insomnia in this setting. Patients (n = 102, 58.3 ± 10.6 years-old) admitted for ACS to a cardiology service at an urban academic medical center completed the Insomnia Severity Index, Epworth Sleepiness Scale, and measures of depression and anxiety. A subset (n = 20) completed ambulatory polysomnography (PSG) in their homes several weeks after discharge. Moderate or severe insomnia was reported by 37% of patients during hospitalization and was associated with 76 minutes more wake after sleep onset measured by home PSG. Although depression and insomnia were strongly associated, about 1 in 4 patients with insomnia did not report significant depressive symptoms. Sleep apnea was documented in 80% of patients on PSG, but insomnia was not associated with sleep apnea, periodic limb movements, demographic factors, or medical conditions other than liver disease. Insomnia is present in over one-third of ACS patients during hospitalization, but at-risk patients could not be readily identified by demographic or medical factors or by depression symptoms.
本研究旨在调查急性冠状动脉综合征（ACS）患者中失眠的患病率及其与抑郁、焦虑和合并症的关联。失眠会增加ACS患者发生心脏事件复发的风险，但在此情况下失眠的患病率及临床相关因素却鲜为人知。入住一家城市学术医疗中心心脏病科的ACS患者（n = 102，年龄58.3±10.6岁）完成了失眠严重程度指数、爱泼沃斯思睡量表以及抑郁和焦虑测量。其中一部分患者（n = 20）在出院几周后在家中完成了动态多导睡眠图（PSG）检查。37%的患者在住院期间报告有中度或重度失眠，且与家庭PSG测量的睡眠起始后觉醒时间多76分钟有关。虽然抑郁与失眠密切相关，但约四分之一的失眠患者未报告有明显的抑郁症状。PSG检查显示80%的患者存在睡眠呼吸暂停，但失眠与睡眠呼吸暂停、周期性肢体运动、人口统计学因素或除肝病外的其他疾病无关。超过三分之一的ACS患者在住院期间存在失眠，但无法通过人口统计学或医学因素或抑郁症状轻易识别出高危患者。
