title: Does sleep quality affects the immediate clinical outcome in patients undergoing coronary artery bypass grafting: A clinico-biochemical correlation.
abstract: OBJECTIVE
  Poor sleep quality is emerging as high prevalence among the patients suffering from cardiometabolic disturbances. The vascular polypeptide endothelin 1 (ET-1) is involved in many of the health disorders. However, its potential involvement in patients having poor sleep quality along with cardiovascular problem is limited. The present study was formulated to conduct a prospective analysis of the relationship between ET-1 and in hospital outcome in sleep disorder patients undergoing routine coronary artery bypass grafting (CABG).
  
  
  METHODS
  A total of 156 patients were enrolled and divided into two groups based on the Pittsburg Sleep Quality Index (PSQI) of ≤5 (Group I, n = 101) or >5 (Group II, n = 55). Blood sample was collected before anesthesia induction (ET-1a) and at 48 h (ET-1b) to analyze the plasma ET-1 and blood sugar level. The patients were monitored for any intraoperative adverse events and postoperative complications during their hospital stay.
  
  
  RESULTS
  Both groups were comparable in relation to age, sex, incidence of smoking and alcohol consumption. The distribution of comorbid conditions was also similar in both groups. The ET-1 level was higher in Group II than Group I before anesthesia induction as well as 48 h postoperatively (4.5 ± 1.75 vs. 10.61 ± 9.3, P = 0.001; 2.08 ± 1.3 vs. 8.3 ± 9.86, P = 0.0001, respectively). The Group II patients had a longer duration of mechanical ventilation (14.6 ± 12.05 vs. 10.1 ± 8.19, P = 0.001), Intensive Care Unit stay (2.08 ± 0.95 vs. 2.7 ± 1.45, P = 0016) and hospital stay (5.98 ± 1.73 vs. 7.8 ± 3.66, P = 0.0001, respectively). The high number of patients from Group II required inotrope and intra-aortic balloon pump support while compared with Group I (P ≤ 0.05 in each). The overall postoperative complication rate was significantly higher among patients with PSQI of >5 (Group II) except the rate of infection and neurological complications which was similar among both group of patients. The postoperative in hospital mortality was nil in Group I and 3.6% in Group II (P = 0.05). There was a strong relationship between PSQI and ET-1 at both the time points.
  
  
  CONCLUSIONS
  Poor sleep quality associated with a higher incidence of adverse perioperative events in patients undergoing elective CABG. There exists a potential link between poor sleep quality and ET-1 in these groups of patients.
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Minati
authors.initials: M
authors.lastname: Choudhury
authors.affiliation: Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anushree
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Milind P
authors.initials: MP
authors.lastname: Hote
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khanna
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M V
authors.initials: MV
authors.lastname: Kalaivani
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
mesh_terms: D015897:Comorbidity; D001026:Coronary Artery Bypass; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000097:blood* / Q000453:epidemiology*
chemical_list: D019332:Endothelin-1