Correlation Between Sleep Quality And Severity Of Coronary Artery Disease

Objective:Cardiovascular diseases are the leading cause of death and disability worldwide.By 2030,the number of cardiovascular disease deaths is expected to increase to more than 24 million,causing a huge burden of disease.Coronary heart disease is one of the most common cardiovascular diseases,and multiple factors are related to coronary heart disease.In recent years,studies have found that sleep,as a basic physiological need of human beings,is closely related to the occurrence and development of coronary heart disease.At present,related studies mainly explore the relationship between sleep duration and coronary heart disease,but there is still a lack of related research on sleep quality and coronary artery stenosis.In this study,Pittsburgh Sleep Quality Index scale was used to evaluate the sleep quality of patients undergoing coronary angiography,and to explore the correlation between sleep quality and the degree of coronary artery stenosis.Methods:Patients with suspected or previously diagnosed coronary heart disease who were hospitalized in the Department of General Practice or Cardiology of the First Affiliated Hospital of Chengdu Medical College from July 2022 to December 2022 and planned to complete or review coronary angiography were enrolled in this study.All enrolled patients underwent coronary angiography,and the Gensini score was used to evaluate the degree of coronary artery stenosis according to the results of coronary angiography.According to the Gensini score,the subjects were divided into four groups: no stenosis group(Gensini score: 0),mild stenosis group(Gensini score: 1-30),moderate stenosis group(Gensini score: 31-60),severe stenosis group(Gensini score>60).All subjects completed the medical history collection,fasting venous blood samples were taken before coronary angiography,and Pittsburgh Sleep Quality Index was recorded.Results:1.The comparison of baseline data among the groups showed that there was a significant difference in age among the groups(F=4.187,P=0.008).The age of patients in the severe coronary artery stenosis group was significantly higher than that in the non-coronary artery stenosis group(P=0.01).There was a statistically significant difference in BMI between the groups(F=6.151,P=0.001),and the higher the BMI,the more severe the coronary artery stenosis,.There was a statistically significant difference in gender among the groups(χ2=8.585,P=0.035).There were more male patients in the severe coronary stenosis group than female patients.There was a significant difference in smoking rate among the three groups(χ2=7.925,P=0.048).There was a statistically significant difference in drinking rate between the two groups(χ2=11.066,P=0.011),and the drinking rate in the severe coronary stenosis group was significantly higher than that in the non-coronary stenosis group.There were significant differences in the prevalence of hypertension among the groups(χ2=32.326,P<0.001).The more severe the coronary artery stenosis,the higher the prevalence of hypertension.There were significant differences in the prevalence of diabetes mellitus(χ2=15.139,P=0.002)and hyperlipidemia(χ2=22.969,P<0.001);2.PSQI scale analysis showed that there were statistically significant differences in sleep evaluation levels among the groups(χ2=49.606,P<0.001).In terms of PSQI total score,the difference between the groups was statistically significant(F=26.717,P<0.001).The PSQI total scores of the mild,moderate and severe coronary stenosis group were significantly higher than those of the non-coronary stenosis group(P<0.001).The PSQI total score was the highest in the severe coronary stenosis group and the lowest in the non-coronary stenosis group.The higher the PSQI total score,the more severe the coronary artery stenosis.In terms of PSQI scale 7 factors,there was a significant difference in subjective sleep quality among the groups(F=5.452,P=0.001),and the degree of coronary artery stenosis gradually increased with the increase of subjective sleep quality.In terms of sleep duration,there were significant differences between the groups(F=6.554,P<0.001).There were significant differences in sleep onset time among the groups(F=12.61,P<0.001).There were significant differences in sleep efficiency among different groups(F=4.549,P=0.004),and the sleep efficiency score was the highest in the severe coronary stenosis group.There were significant differences in the scores of hypnotic drugs among the groups(F=6.468,P=0.001).There were significant differences in daytime dysfunction scores between the groups(F=7.408,P<0.001);3.There were significant differences in IL-6 levels between groups(F=28.257,P<0.001).There were also significant differences in TNF-ɑ levels among the groups(F=67.914,P<0.001).Correlation analysis showed that there was a significant correlation between PSQI total score and IL-6(r= 0.392,P<0.001);PSQI score was significantly correlated with TNF-ɑ(r=0.399,P<0.001),the higher the PSQI total score,the higher the levels of inflammatory factors.There was a significant moderate correlation between the degree of coronary stenosis and IL-6(r=0.517,P<0.001);The degree of coronary artery stenosis was significantly and strongly correlated with TNF-ɑ(r=0.732,P<0.001).The degree of coronary stenosis was significantly positively correlated with PSQI total score(r=0.477,P<0.001),and the correlation with the evaluation grade was also strong(r=0.485,P<0.001);4.Logistic regression analysis showed that: Increasing age(OR=1.055,95%CI:1.023-1.087,P=0.001),being male(OR=2.119,95%CI:1.065-4.219,P=0.033),smoking(OR=2.866,95%CI:1.326-6.192,P=0.033),P=0.007),increased BMI(OR=1.134,95%CI:1.021-1.26,P=0.019),hypertension(OR=2.524,95%CI:1.286-4.952,P=0.007),diabetes(OR=2.073,P=0.007),95%CI :1.048-4.102,P=0.036),hyperlipidemia(OR=3.228,95%CI:1.673-6.229,P<0.001),longer time to fall asleep(OR=2.296,95%CI:1.41-3.736,P=0.001),poorer subjective sleep quality(OR=1.954,95%CI:1.242-3.075,P=0.006),shorter sleep duration(OR=1.776,P=0.001).95%CI:1.198-2.633,P=0.005),higher PSQI total score(OR=1.284,95%CI:1.157-1.426,P<0.001),low evaluation grade(ok vs very good: OR=3.877,95%CI:1.397-10.758,P=0.009;Fair vs very good: OR=14.608,95%CI:4.544-46.956,P<0.001;Very poor vs very good: OR =15.898,95%CI:2.707-93.377,P=0.002)were independent risk factors for the severity of coronary artery stenosis.5.Subgroup analysis showed: In the subgroups of age< 60 years old and age≥ 60 years old,high PSQI total score was risk factors for the aggravation of coronary artery stenosis.High PSQI total score was a risk factor for the severity of coronary artery stenosis in the male subgroup,but the results was not statistically significant in the female subgroup.Whether drinking or not,high PSQI total score was a risk factor for the aggravation of coronary artery stenosis.A high PSQI total score was a risk factor for the severity of coronary artery stenosis in both smoking and non-smoking subgroups.In the subgroups of BMI < 24kg/m2 and BMI≧24kg/m2,high PSQI total score was risk factors for the severity of coronary artery stenosis.High PSQI total score was a risk factor for the aggravation of coronary artery stenosis regardless of hypertension,diabetes or hyperlipidemia.Conclusion:1.Sleep quality is closely related to the degree of coronary artery stenosis,and poor sleep quality is an independent risk factor for the aggravation of coronary artery stenosis.The worse the sleep quality,the more severe the coronary artery stenosis.2.Long sleep latency period and shorter sleep duration may increase the risk of coronary artery disease.3.Inflammatory pathway may mediate the relationship between poor sleep quality and the severity of coronary artery disease.4.Increased age,male,smoking,increased BMI,hypertension,diabetes and hyperlipidemia were the risk factors for the aggravation of coronary artery stenosis.