title: Symptoms of disturbed sleep predict major adverse cardiac events after percutaneous coronary intervention.
abstract: BACKGROUND
  Disturbed sleep is associated with atherosclerosis in native coronary arteries and may be associated with adverse cardiac events after percutaneous coronary intervention (PCI). We sought to determine the association between symptoms of disturbed sleep and adverse cardiovascular events after PCI.
  
  
  METHODS
  Outpatients who were stable after successful PCI were assessed for symptoms of disturbed sleep with 10 true/false questions. Follow-up was performed at least 4 years after PCI. The primary outcome was a composite of death, myocardial infarction (MI), and repeated revascularization.
  
  
  RESULTS
  Three hundred eighty-eight patients (mean age, 66 ± 11 years) reported on average 3.1 ± 2.1 sleep disturbance symptoms. Follow-up was performed on average 4.4 years after the incident PCI. The primary outcome occurred in 25% of patients. An association was seen between the number of sleep disturbance symptoms and the occurrence of the primary end point. Patients with zero symptoms had a 4-year event rate of 12% compared with a 67% event rate for those with 9 symptoms. On multivariable analysis, sleep symptoms, diabetes mellitus, and the number of diseased coronary vessels were independently associated with the primary end point. Each additional sleep symptom was associated with a hazard ratio (HR) of 1.2 (P = 0.001). The results were driven primarily by the association between symptoms of disturbed sleep and the need for repeated revascularization (repeated PCI HR, 1.9; P = 0.003; coronary artery bypass grafting (CABG) HR, 1.5; P = 0.001).
  
  
  CONCLUSIONS
  Symptoms of disturbed sleep were associated with increased risk of long-term adverse cardiovascular outcomes after successful PCI.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nisha M
authors.initials: NM
authors.lastname: Fernandes
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Nield
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Najla
authors.initials: N
authors.lastname: Popel
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: Division of Cardiology, Department of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Plante
authors.affiliation: Division of Cardiology, Department of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Lorne
authors.initials: L
authors.lastname: Goldman
authors.affiliation: Division of Cardiology, Department of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Manu
authors.initials: M
authors.lastname: Prabhakar
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Southlake Regional Health Center, Newmarket, Ontario, Canada. Electronic address: sminer@southlakeregional.org.
authors.forename: Steven E S
authors.initials: SE
authors.lastname: Miner
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011184:Postoperative Period; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors