| Objective:With the changes in lifestyle brought by economic development and the aging of the population,cardiovascular disease has become the primary cause of death and disease burden among Chinese residents,among which coronary heart disease is the most common and one of the main disabling and fatal diseases.Insomnia and dyscoimesis are also common problems.Short sleep or poor sleep quality can negatively impact quality of life,mood,cognitive function,increased use of medical resources,and health.In the past,sleep was not generally considered a traditional risk factor for cardiovascular disease,but now there is increasing evidence supporting poor sleep and cardiovascular disease risk.Existing research on sleep and coronary heart disease outcomes has focused on one aspect of sleep(e.g.,sleep duration)and less on others.In this study,the Pittsburgh sleep quality index(PSQI)was used to investigate the relationship between sleep duration,sleep quality and coronary artery stenosis in patients with coronary heart disease.Methods:The subjects of this study were patients who were admitted to the department of cardiology,Changhai hospital,Shanghai from February 2019 to June 2019 and underwent coronary angiography.According to the results of coronary angiography,the subjects were divided into four groups:no atherosclerosis group,coronary atherosclerosis group with stenosis degree<50%,coronary heart disease group with stenting degree?70%and coronary heart disease group with>70%.Complete medical history was collected for all subjects,routine blood tests were performed on admission,and bedside data were registered by questionnaires.The PSQI scale was evaluated in all four groups.Variance analysis was used to compare the differences in age and PSQI scores of patients in each group,and Cochran-Mantel-Haenszel?~2test was used to compare the differences in gender,hypertension,diabetes,hyperlipidemia and Pittsburgh sleep quality index degree.In this study,a univariate and three multivariate logistic regression models were constructed to evaluate the relationship between the degree of coronary atherosclerotic stenosis and the clinical factors and sleep status of the patients.To explore the potential effects of gender,age and comorbidities,we performed subgroup analyses on gender,age(<55,55-65,?65),hypertension,diabetes,and hyperlipidemia.Finally,we used propensity score matching to sensitivity analysis.The no atherosclerosis group and degree of stenosis<50%of coronary atherosclerosis group were defined as the coronary heart disease group,and the others were defined as the coronary heart disease group.We used the nearest neighbor matching method and set the caliper value to 0.1.After matching the two groups one to one,the regression analysis was carried out.Results:(1)A total of 302 cases were included in this study.There are 32 cases in the non-coronary atherosclerosis group,58 cases in the stenosis degree<50%group,49 cases in the 50%?stenosis degree?70%group,and 159 cases in the stenosis degree>70%group.The analysis of the baseline results of each group showed that there was a statistically significant difference in age between each group(P=0.0151).The age of the coronary heart disease group without stenting(50%?stenosis?70%)and the coronary heart disease group with stenting(>70%)was significantly higher than that of the group without coronary atherosclerosis.The gender difference in each group was statistically significant(P=0.0005),and the proportion of men in the coronary heart disease group with>70%stent implantation was significantly higher than that of women.There were no statistically significant differences in hypertension and hyperlipidemia among the groups(P=0.1157,P=0.7404),while there were statistically significant differences in diabetes among the groups(P=0.0204).(2)The total score of PSQI in each group was significantly different(P<0.0001),and the coronary heart disease group with 70%>stenosis was the highest,reaching 8.14±0.31points.The difference in sleep quality score was statistically significant(P<0.0001).The coronary heart disease group without stent implantation with 50%?stenosis?70%had the worst sleep quality,with a score as high as 1.36±0.06.The score of time to sleep in each group was significantly different(P=0.0014).The coronary heart disease group without stent implantation with 50%?stenosis?70%had the highest score,reaching 1.55±0.13points.The score of sleep time in each group was statistically significant(P=0.0209).The coronary heart disease group with 70%>stenosis had the highest score,reaching0.96±0.06.There was a statistically significant difference in the score of daytime dysfunctions in each group(P=0.0001).The coronary heart disease group with 50%?stenosis?70%without stent implantation had the highest score,reaching 1.86±0.13 points.The scores of sleep efficiency,sleep disorder and hypnotic drugs in each group were not significantly different(P=0.2989,P=0.1667,P=0.1449,respectively).In terms of PSQI score,Spearman level correlation analysis showed that the PSQI score was positively correlated with the degree of atherosclerosis(P<0.0001),and the worse the PSQI score was,the more severe the coronary stenosis was.(3)In the multivariate regression model,increased age(OR=1.04,95%CI:1.02–1.08,P=0.0028),hypertension(OR=1.64,95%CI:1.02–2.65,P=0.0431),and diabetes(OR=2.27,95%CI:1.16–4.46,P=0.0017)were associated with increased coronary stenosis,and gender was still a protective factor for women(OR=0.34,95%CI:0.21–0.55,P<0.0001),poorer sleep quality(OR=1.75,95%CI:1.14-2.69,P=0.0106),shorter sleep duration(OR=1.75,95%CI:1.05-2.25,P=0.0287),and more daytime dysfunction(OR=1.13,95%CI:1.06-1.20,P=0.0001)were independent risk factors for increased coronary stenosis.Higher PSQI score(OR=1.13,95%CI:1.06-1.20,P=0.0001)and lower PSQI score were associated with increased coronary stenosis.(4)Subgroup analysis showed that higher total PSQI score was a risk factor for increased coronary stenosis in both male and female.In the subgroup aged 55-65 years and?65 years,the total PSQI score was higher(55-65 years:OR=1.11,95%CI:1.01–1.22,P=0.0252;?65 years:OR=1.29,95%CI:1.15–1.45,P<0.0001)was still a risk factor for increased coronary stenosis,while the results were not statistically significant in subjects<55 years old.Higher total PSQI score was a risk factor for increased coronary stenosis regardless of hypertension.In the non-diabetic subgroup,a higher total PSQI score was a risk factor for increased coronary stenosis,while in the diabetic subgroup,the results were not statistically significant.In the subgroup without hyperlipidemia,a higher total score of PSQI was a risk factor for increased coronary stenosis,while in the subgroup with hyperlipidemia,the results were not statistically significant.(5)After the propensity score was matched,a total of 170 patients were enrolled,85each in the non-CHD group and CHD group.Compared with the non-CHD group,CHD group had poorer sleep quality(P=0.0009),longer sleep(P=0.0037),shorter sleep(P=0.0139),more daytime dysfunction(P=0.0012),higher PSQI scores(P=0.0015),and worse evaluation grades(P<0.0001).In the multivariate regression model,poorer sleep quality(OR=2.09,95%CI:1.27-3.43,P=0.0036),longer to fall asleep(OR=1.41,95%CI:1.01–1.96,P=0.0428),shorter sleep time(OR=1.60,95%CI:1.03-2.50,P=0.0378),more daytime dysfunction(OR=1.55,95%CI:1.12–2.14,P=0.0077),and a higher total score of PSQI(OR=1.16,95%CI:1.08-1.26,P=0.0002)were associated with coronary heart disease.Conclusion:(1)By analyzing the sleep characteristics of patients with different degrees of coronary artery stenosis and comparing the differences,this study concluded that there is a close relationship between poor sleep and the severity of coronary artery stenosis.The worse the sleep,the more severe the coronary stenosis.(2)Our study found that poor sleep quality,less sleep time and daytime dysfunction were independent risk factors for increased coronary stenosis.In addition,our study also found that hypertension?diabetes and age growth are closely related to the severity of coronary stenosis,and gender of female is a protective factor for the severity of coronary stenosis.(3)Getting enough sleep should be considered an important part of a healthy lifestyle.Sleep is a modifiable lifestyle and good sleep can reduce the risk of coronary heart disease,but further research is needed to better elucidate the mechanism of sleep's association with coronary artery stenosis. |
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