Sleep disorders and cardiovascular disease

Sleep disturbances have a high
incidence in the general population.
The most common sleep disorder is insomnia, followed by sleep-disordered breathing such as obstructive sleep apnea (OSA).

Sleep disorders are clearly linked to the development and progression of hypertension, cardiovascular and cerebrovascular diseases, obesity, diabetes, neurodegenerative diseases and cancer, and have become public health problems [1].

01Stay up late and be sad!

Circadian rhythm disturbances lead to poor prognosis in patients with myocardial infarction

On May 24, 2022, a clinical study published in the Journal of the American College of Cardiology by the team of Professor Bu Jun of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine [2] showed that circadian rhythm disturbances such as staying up late or working night shifts may aggravate myocardial injury after emergency reperfusion in patients with acute myocardial infarction, resulting in poor long-term clinical prognosis
.
In a prospective, multicenter clinical study, we continuously included patients with acute ST-segment elevation myocardial infarction who underwent emergency reperfusion surgery within 12 hours of onset
.
The primary clinical endpoint was the area of myocardial infarction after reperfusion, and the secondary clinical endpoint was major adverse cardiovascular events including death, myocardial infarction, heart failure, and stroke
.
Studies have found that night shift work significantly increases the risk of
myocardial reperfusion injury and microcirculation disorders in patients with acute myocardial infarction.
During the median follow-up period of 5 years, night shift workers had a nearly 2-fold increased risk of adverse cardiovascular events, which was mainly related to
the increased risk of heart failure after myocardial infarction.

02Sleep disturbances increase the risk of cardiovascular disease

A new study published in the journal PLOS Biology by scholars at the University of California, Berkeley [3]: Lack of sleep exacerbates atherosclerosis and may increase the risk of stroke by influencing inflammatory pathways, through statistical modeling, researchers analyzed diagnostic data
from more than 1600 middle-aged and elderly adults using a national dataset known as the "Atherosclerosis Multiethnic Study.
" To isolate the effects of sleep quality on heart health, the study controlled for high-risk behaviors such as age, race, gender, body mass index, sleep disturbances, blood pressure and smoking
.
The researchers then followed the study participants' results, analyzing their blood tests, calcium scores (which measure the buildup of plaques), and several different sleep indicators, including a 1-week watch to assess sleep and a night's brainwave signals
measured in the sleep lab.
The end results clearly show that disturbances in sleep patterns are associated with high concentrations of circulating inflammatory factors, especially leukocytes (monocytes and neutrophils), which are key factors
leading to atherosclerosis.

03Diagnosis and treatment of sleep disorders

The first-line treatment for insomnia is cognitive behavioral therapy, where maintaining good sleep hygiene is an important component of cognitive behavioral therapy and is often the only treatment
needed for patients with mild sleep problems.
If hypnotics are used, guidelines should be followed to reduce abuse, misuse, and dependence
.
Non-invasive positive ventilation (NPPV), as a first-line treatment for OSA, helps to eliminate hypoxia during sleep, correct sleep structure disorders, improve sleep quality and quality of life, and reduce related morbidity and mortality
.
It is recommended to implement it under the guidance of professional medical staff, and select the appropriate NPPV working mode
according to the specific situation of the patient.
For patients with sleep disorders and coronary heart disease, it is recommended to actively take secondary prevention drugs for coronary heart disease in the early stage, and the combination of proprietary Chinese medicines may obtain better clinical prognosis, such as Musk Baoxin Pill
that promotes therapeutic angiogenesis.

Sleep is a basic physiological process, and sleep loss, long-term sleep deprivation, replacement rhythms, and decreased sleep quality are all major problems
in modern society.
The right amount of high-quality sleep not only maintains normal physiology, but also prevents hypertension, cardiovascular disease, and other chronic diseases, and more prospective cohort studies are needed to explore the link between sleep disturbance and cardiovascular risk factors, and to find appropriate treatments
.