Association between self-reported quantity and quality of sleep with recurrent cardiovascular events
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Objective. To evaluate the association between quantity and quality of sleep with recurrent cardiovascular events (RCE) in patients with incident myocardial infarction. Study design and settings. The current study utilized data from the Western New York Acute Myocardial Infarction (WNYAMI) study. In the WNYAMI, participants were recruited from hospitals in Erie and Niagara counties after having an initial diagnosed myocardial infarction (MI). These individuals were then followed up in the study starting in 1996 and were followed up for subsequent cardiovascular outcomes. Results. Investigations of sleep duration and RCE show that while trends were present for an increased risk of having a RCE among those that sleep for less than six hours and over eight hours - these were not statistically significant. There was a statistically significant 50% reduction in the risk of an RCE, in individuals older than 55 years of age that reported sleep durations of greater than eight hours on average. Such association in this subgroup was present in the evaluation of average sleep over weekdays, weekends and in an overall week. Upon examining all-cause mortality associations, there was an increased risk of mortality associated with short sleep durations. This association persisted in both subgroups i.e., those that were younger and those older than the median age. In the analyses of individuals that reported disturbed sleep behavior and poor daytime functioning there were trends suggesting an increased hazard of a RCE but these were not statistically significant. In the evaluation of apneic sleep behavior, however, there was a statistically significant reduction in risk that was observed among individuals reporting such sleep behavior. Conclusion. In summary, it appears that there is a benefit to sleeping more than eight hours for individuals older than 55 years of age. Among younger participants the same benefit was not observed. Given the evidence, it can be concluded that sleep quantity and quality are associated with recurrent cardiovascular outcomes and that more investigation is warranted to conclusively determine the potential intermediary mechanisms.