急性心肌梗死患者睡眠问题与神经内分泌激素及凝血因子的关联
Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction.
作者信息
von Känel Roland, Princip Mary, Schmid Jean-Paul, Barth Jürgen, Znoj Hansjörg, Schnyder Ulrich, Meister-Langraf Rebecca E
机构信息
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland.
Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland.
出版信息
BMC Cardiovasc Disord. 2018 Nov 21;18(1):213. doi: 10.1186/s12872-018-0947-5.
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 .
背景
阻塞性睡眠呼吸暂停（OSA）和失眠是常见的睡眠问题，与冠心病患者的不良预后相关。睡眠不佳与心血管风险增加之间的关联机制尚未完全明确。我们研究了急性心肌梗死患者中，高OSA风险以及失眠症状是否与神经内分泌激素和凝血因子有关。
方法
我们在急性冠状动脉介入治疗的48小时内，通过OSA风险评估（用于评估高OSA风险与低OSA风险的STOP筛查工具）和失眠症状严重程度评估（用于评估主观睡眠困难的詹金斯睡眠量表），对190例患者（平均年龄60岁，男性占83%）进行了评估。次日早晨测量了肾上腺素、去甲肾上腺素、皮质醇、纤维蛋白原、D - 二聚体和血管性血友病因子的循环浓度。分别使用多变量模型计算OSA风险和失眠症状与神经内分泌激素和凝血因子之间的关联，在失眠症状模型中对人口统计学因素、健康行为、躯体和精神合并症、心脏病相关变量以及OSA风险进行调整，在OSA风险模型中对失眠症状进行调整。
结果
41%的患者被确定为高OSA风险，27%的患者报告有临床相关的失眠症状。与低OSA风险患者相比，高OSA风险患者的肾上腺素水平较低（p = 0.015）、去甲肾上腺素水平较低（p = 0.049）以及皮质醇水平较低（p = 0.001）。更严重的失眠症状与较高的纤维蛋白原水平相关（p = 0.037），这是由入睡困难导致的，并且与较低的去甲肾上腺素水平相关（p = 0.024），这是由维持睡眠困难导致的。
结论
在急性心肌梗死患者中，睡眠问题与神经内分泌激素和凝血活性相关。对于高OSA风险患者和有失眠症状的患者，这些关系的模式并不一致，它们是否会导致不良心血管结局尚需确定。
试验注册
ClinicalTrials.gov NCT01781247 。
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