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CLINICAL

NEWS

American College of Cardiology Extended Learning

Disturbed Sleep, Aging and CVD
Why sleep is a big CV risk factor

M

ore than 70% of patients with heart
failure (HF) report poor sleep and 50%
report insomnia symptoms, including
difficulty initiating sleep, maintaining sleep, or
awakening too early in the morning.
This is of concern because insomnia
is associated with daytime symptoms
and negative functional and quality
of life (QOL) outcomes among HF
patients who suffer disproportionately
from these concerns.
One of the biggest issues—seen
broadly in patients with cardiovascular disease (CVD), not just those
with advanced disease—is sleepdisordered breathing (SDB), such as
sleep apnea. In one study of 170 patients, full polysomnography testing
demonstrated that 51% of patients
with stable chronic HF had SDB.1
That might be a surprise to you,
since patients freely admit they are
not sharing such information with
you. Nancy S. Redeker, PhD, RN, a
professor at Yale School of Nursing,
and her colleagues, who conducted
that study on the prevalence of SDB
in the setting of stable HF, have
shown that patients use a variety of
strategies to manage their insomnia,
but generally do not mention their
sleep concerns to physicians “whom
they perceived as not interested in
sleep.”2 In short, from the patient’s
perspective: “Docs don’t ask, we
don’t tell.”

nia and hypertension (a three- to five-fold increased
risk depending on the hours of sleep achieved.
There also appears to be a strong dose-dependent
association between the number of insomnia symp-

toms and acute MI as well as HF risk. It’s not just in
older patients, either. In one study of active military
service members, insomnia was associated with a
two-fold increased risk of diabetes.3 (This was an

PUT EFFIENT (PRASUGREL)
IN HIS CORNER
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HE’S A MIDDLE-AGED STEMI-PCI PATIENT. HE’S A FATHER.
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WHY SHOULD YOU BE
INTERESTED IN SLEEP
PROBLEMS?
Like SDB, both poor sleep quality
and insomnia have negative consequences in patients (TABLE) that
could drive CVD. For example, sleep
quality and insomnia are associated
with poor physical function, shorter
6MWD, fatigue/malaise, mood disturbance/irritability, and proneness
to errors and accidents. Individuals
with insomnia are five times more
likely to be depressed than those
without insomnia. Not surprisingly,
sleep disturbances are associated
with poor medication adherence.

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TO SLEEP, PERCHANCE TO
DREAM STUDY
Importantly, it’s not just a QOL issue;
there is a strong link between insom-

20 CardioSource WorldNews

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