title: Sleep quality and duration - potentially modifiable risk factors for Coronary Artery Disease?
abstract: OBJECTIVE
  Previous studies have shown that lack of sleep exerts deleterious effects on a variety of systems with detectable changes in metabolic, endocrine and immune pathways. Both short and long sleep durations are related to increased likelihood of diabetes and hypertension. However, the relation between sleep duration, sleep quality and Coronary Artery Disease (CAD) is not clear in the Indian population. We examined the hypothesis that sleep duration (compared with <6 h) and quality of sleep (PSQI > 5) are risk factors for CAD.
  
  
  METHODS
  A retrospective & controlled study was conducted on 352 adult (>18 yrs) subjects (176 controls and 176 cases, 60% men, age M = 51 ± 9.38). Sleep quality and duration was measured with Pittsburg Sleep Quality Index (PSQI). Poor sleep quality and short sleep duration was defined as PSQI >5 and total sleep time <6.0 h, respectively. OSA patients were excluded from the study. The main outcome of interest was the presence of any CAD (n = 176), including MI, angina, and stroke. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using Multivariate Logistic Regression analysis.
  
  
  RESULTS
  We found both poor quality of sleep and short sleep duration to be independently associated with CAD. Compared with a total sleep time of 6.0 h, the multivariate odds ratio (95% confidence interval) of CAD was 3.81 (1.69-8.58) whereas for poor sleep quality (PSQI > 5) it came out to be 16.62 (9.13-30.28).
  
  
  CONCLUSIONS
  There was a positive association between both short sleep duration and poor sleep quality with CAD in a selected sample of Indian adults. These results suggest that poor sleep quality and short sleep duration may be important modifiable CAD risk factors in the Indian population.
authors: Consultant Clinical Psychologist, Dharam Vira Heart Institute, Department of Sleep Medicine, Sir Ganga Ram Hospital, New Delhi, India. Electronic address: Monika21in@gmail.com.
authors: Monika
authors: M
authors: Sharma
authors: Consultant Cardiologist, Dharam Vira Heart Institute, Sir Ganga Ram Hospital, New Delhi, India.
authors: J P S
authors: JP
authors: Sawhney
authors: Consultant Neurophysiologist, Department of Sleep Medicine, Sir Ganga Ram Hospital, New Delhi, India.
authors: Samhita
authors: S
authors: Panda
mesh_terms: D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications*
keywords: Coronary Artery Disease; Sleep duration; Sleep quality
references: Arch Gen Psychiatry. 2002 Feb;59(2):131-6
references: 11825133
references: Arch Intern Med. 2003 Jan 27;163(2):205-9
references: 12546611
references: Arch Gen Psychiatry. 1979 Jan;36(1):103-16
references: 760693
references: Sleep. 1983;6(2):102-7
references: 6878979
references: Psychiatry Res. 1989 May;28(2):193-213
references: 2748771
references: J Clin Hypertens (Greenwich). 2006 Nov;8(11):819-22
references: 17086023
references: Sleep. 2010 Jun;33(6):739-44
references: 20550013
references: Hypertension. 2007 Oct;50(4):693-700
references: 17785629
references: Sleep. 2009 Mar;32(3):295-301
references: 19294949
references: Arch Intern Med. 2009 Apr 13;169(7):717
references: 19365006
references: Diabetes Care. 2010 Feb;33(2):414-20
references: 19910503
references: J Epidemiol. 2010;20(2):106-10
references: 20009370
references: Sleep Med. 2007 Sep;8(6):668-80
references: 17383936