Short Sleep Duration, Obstructive Sleep Apnea, Shiftwork, and the Risk of Adverse Cardiovascular Events in Patients After an Acute Coronary Syndrome

Laura K Barger, Shantha M W Rajaratnam, Christopher P Cannon, Mary Ann Lukas, KyungAh Im, Erica L Goodrich, Charles A Czeisler, Michelle L O'Donoghue, Laura K Barger, Shantha M W Rajaratnam, Christopher P Cannon, Mary Ann Lukas, KyungAh Im, Erica L Goodrich, Charles A Czeisler, Michelle L O'Donoghue

Abstract

Background: It is unknown whether short sleep duration, obstructive sleep apnea, and overnight shift work are associated with the risk of recurrent cardiovascular events in patients after an acute coronary syndrome.

Methods and results: SOLID-TIMI 52 (The Stabilization of PLaques UsIng Darapladib-Thrombolysis in Myocardial Infarction 52 Trial) was a multinational, double-blind, placebo-controlled trial that enrolled 13 026 patients ≤30 days of acute coronary syndrome. At baseline, all patients were to complete the Berlin questionnaire to assess risk of obstructive sleep apnea and a sleep and shift work survey. Median follow-up was 2.5 years. The primary outcome was major coronary events (MCE; coronary heart disease death, myocardial infarction, or urgent revascularization). Cox models were adjusted for clinical predictors. Patients who reported <6 hours sleep per night had a 29% higher risk of MCE (adjusted hazard ratio, 1.29; 95% confidence interval, 1.12-1.49; P<0.001) compared with those with longer sleep. Patients who screened positive for obstructive sleep apnea had a 12% higher risk of MCE (1.12; 1.00-1.24; P=0.04) than those who did not screen positive. Overnight shift work (≥3 night shifts/week for ≥1 year) was associated with a 15% higher risk of MCE (1.15; 1.03-1.29; P=0.01). A step-wise increase in cardiovascular risk was observed for individuals with more than 1 sleep-related risk factor. Individuals with all 3 sleep-related risk factors had a 2-fold higher risk of MCE (2.01; 1.49-2.71; P<0.0001).

Conclusions: Short sleep duration, obstructive sleep apnea, and overnight shift work are under-recognized as predictors of adverse outcomes after acute coronary syndrome. Increased efforts should be made to identify, treat, and educate patients about the importance of sleep for the potential prevention of cardiovascular events.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01000727.

Keywords: cardiovascular risk; night shift; obstructive sleep apnea; sleep; sleep disorders.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Adjusted risk of cardiovascular events based on reported sleep duration. Fewer than 6 hours of nightly sleep is indicated with a black bar and 6 hours or more with a gray bar. adj HR indicates adjusted hazard ratio; CHD, coronary heart disease; CV, cardiovascular; MACE, major adverse cardiac events; MCE, major coronary events; MI, myocardial infarction.
Figure 2
Figure 2
Adjusted risk of cardiovascular events based on risk of obstructive sleep apnea (OSA) as assessed by the Berlin questionnaire. Low risk of OSA is indicated by a gray bar and high risk of OSA with a black bar. adj HR indicates adjusted hazard ratio; CHD, coronary heart disease; CV, cardiovascular; MACE, major adverse cardiac events; MCE, major coronary events; MI, myocardial infarction.
Figure 3
Figure 3
Adjusted risk of cardiovascular events based on history of overnight shift work. Patients with at least 1 year of overnight shift work (≥3 nights/week) are indicated with a black bar. adj HR indicates adjusted hazard ratio; CHD, coronary heart disease; CV, cardiovascular; MACE, major adverse cardiac events; MCE, major coronary events; MI, myocardial infarction.
Figure 4
Figure 4
Adjusted risk of cardiovascular events based on the number of positive sleep‐related factors (ie, risk of obstructive sleep apnea, short sleep duration, and history of shift work). No sleep‐related factors is the referent group. One sleep‐related risk factor is indicated by an open bar, 2 sleep‐related risk factors is indicated by a gray bar, and 3 sleep‐related risk factors is indicated by a black bar (*P≤0.01; **P≤0.001). CV indicates cardiovascular; MACE, major adverse cardiac events; MCE, major coronary events; MI, myocardial infarction.

References

    1. Buxton OM, Cain SW, O'Connor SP, Porter JH, Duffy JF, Wang W, Czeisler CA, Shea SA. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption. Sci Transl Med. 2012;4:129ra143.
    1. Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci USA. 2009;106:4453–4458.
    1. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta‐analysis of prospective studies. Eur Heart J. 2011;32:1484–1492.
    1. Dong J, Zhang Y, Qin L. Obstructive sleep apnea and cardiovascular risk: meta‐analysis of prospective cohort studies. Atherosclerosis. 2013;229:489–495.
    1. Centers for Disease Control and Prevention . Short sleep duration among workers—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:281–285.
    1. King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS. Short sleep duration and incident coronary artery calcification. JAMA. 2008;300:2859–2866.
    1. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta‐analysis. Diabetes Care. 2010;33:414–420.
    1. Grandner MA, Hale L, Moore M, Patel NP. Mortality associated with short sleep duration: the evidence, the possible mechanisms, and the future. Sleep Med Rev. 2010;14:191–203.
    1. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all‐cause mortality: a systematic review and meta‐analysis of prospective studies. Sleep. 2010;33:585–592.
    1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep‐disordered breathing in adults. Am J Epidemiol. 2013;177:1006–1014.
    1. Raghuram A, Clay R, Kumbam A, Tereshchenko LG, Khan A. A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias. J Clin Sleep Med. 2014;10:1155–1160.
    1. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–2041.
    1. Young T, Finn L, Peppard PE, Szklo‐Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen‐year follow‐up of the Wisconsin sleep cohort. Sleep. 2008;31:1071–1078.
    1. Suwazono Y, Dochi M, Sakata K, Okubo Y, Oishi M, Tanaka K, Kobayashi E, Nogawa K. Shift work is a risk factor for increased blood pressure in Japanese men: a 14‐year historical cohort study. Hypertension. Sep 2008;52:581–586.
    1. Sakata K, Suwazono Y, Harada H, Okubo Y, Kobayashi E, Nogawa K. The relationship between shift work and the onset of hypertension in male Japanese workers. J Occup Environ Med. 2003;45:1002–1006.
    1. Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Speizer FE, Hennekens CH. Prospective study of shift work and risk of coronary heart disease in women. Circulation. 1995;92:3178–3182.
    1. Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210.
    1. O'Donoghue ML, Braunwald E, White HD, Serruys P, Steg PG, Hochman J, Maggioni AP, Bode C, Weaver D, Johnson JL, Cicconetti G, Lukas MA, Tarka E, Cannon CP. Study design and rationale for the Stabilization of pLaques using Darapladib‐Thrombolysis in Myocardial Infarction (SOLID‐TIMI 52) trial in patients after an acute coronary syndrome. Am Heart J. 2011;162:613–619.e1
    1. O'Donoghue ML, Braunwald E, White HD, Lukas MA, Tarka E, Steg PG, Hochman JS, Bode C, Maggioni AP, Im K, Shannon JB, Davies RY, Murphy SA, Crugnale SE, Wiviott SD, Bonaca MP, Watson DF, Weaver WD, Serruys PW, Cannon CP; SOLID‐TIMI 52 Investigators , Steen DL. Effect of darapladib on major coronary events after an acute coronary syndrome: the SOLID‐TIMI 52 randomized clinical trial. JAMA. 2014;312:1006–1015. Erratum in: JAMA. 2014;312:1473.
    1. Jungquist CR, Mund J, Aquilina AT, Klingman K, Pender J, Ochs‐Balcom H, van Wijngaarden E, Dickerson SS. Validation of the behavioral risk factor surveillance system sleep questions. J Clin Sleep Med. 2016;12:301–310.
    1. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–491.
    1. Senaratna CV, Perret JL, Matheson MC, Lodge CJ, Lowe AJ, Cassim R, Russell MA, Burgess JA, Hamilton GS, Dharmage SC. Validity of the Berlin questionnaire in detecting obstructive sleep apnea: a systematic review and meta‐analysis. Sleep Med Rev. 2017. pii: S1087‐0792(16)30145‐9. DOI: 10.1016/j.smrv.2017.04.001. [Epub ahead of print] Review.
    1. Consensus Conference Panel , Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med. 2015;11:931–952.
    1. Cardiovascular diseases . Media Centre Fact Sheet. World Health Organization; Reviewed September 2016. Available at: . Accessed August 18, 2017.
    1. Heron M. Deaths: Leading Causes for 2010. National Vital Statistics Reports, Volume 62, Number 6, December 20, 2013. U.S. Department Of Health And Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System Hyattsville, MD: National Center for Health Statistics; 2013.
    1. Bin YS, Marshall NS, Glozier N. Sleeping at the limits: the changing prevalence of short and long sleep durations in 10 countries. Am J Epidemiol. 2013;177:826–833.
    1. Ayas N, White D, Manson J, Stampfer MJ, Speizer FE, Malhotra A, Hu FB. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–209.
    1. Patel S, Malhotra A, White D, Gottlieb D, Hu F. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164:947–954.
    1. Gottlieb D, Redline S, Nieto F, Baldwin CM, Newman AB, Resnick HE, Punjabi NM. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006;29:1009–1014.
    1. Gangwisch J, Heymsfield S, Boden‐Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006;47:833–839.
    1. Eguchi K, Pickering T, Schwartz J, Hoshide S, Ishikawa J, Ishikawa S, Shimada K, Kario K. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med. 2008;168:2225–2231. Erratum in: Arch Intern Med. 2009;169:154.
    1. Yaggi H, Araujo A, McKinlay J. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care. 2006;29:657–661.
    1. Patel S, Ayas N, Malhotra M, White DP, Schernhammer ES, Speizer FE, Stampfer MJ, Hu FB. A prospective study of sleep duration and mortality risk in women. Sleep. 2004;27:440–444.
    1. Aurora RN, Kim JS, Crainiceanu C, O'Hearn D, Punjabi NM. Habitual sleep duration and all‐cause mortality in a general community sample. Sleep. 2016;39:1903–1909.
    1. Rajaratnam SMW, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O'Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA; Harvard Work Hours, Health and Safety Group . Sleep disorders, health, and safety in police officers. JAMA. 2011;306:2567–2578.
    1. Barger LK, Rajaratnam SM, Wang W, O'Brien CS, Sullivan JP, Qadri S, Lockley SW, Czeisler CA; Harvard Work Hours Health and Safety Group . Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. J Clin Sleep Med. 2015;11:233–240.
    1. Sommerfeld A, Althouse AD, Prince J, Atwood CW, Mulukutla SR, Hickey GW. Obstructive sleep apnea is associated with increased readmission in heart failure patients. Clin Cardiol. 2017. Jun 6. DOI: 10.1002/clc.22738. [Epub ahead of print]
    1. Statistics BoL . Workers on flexible and shift schedules in May 2004. Available at: . Accessed January 12, 2016.
    1. Ftouni S, Sletten TL, Barger LK, Lockley SW, Rajaratnam SM. Shift work disorder In: Barkoukis T, Matheson JK, Ferber R, Doghramji K, eds. Therapy in Sleep Medicine. Amsterdam, The Netherlands: Elsevier; 2011:378–389.
    1. Dijk D, Czeisler C. Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. J Neurosci. 1995;15:3526–3538.
    1. Knutsson A, Akerstedt T, Jonsson B, Orth‐Gomer K. Increased risk of ischaemic heart disease in shift workers. Lancet. 1986;2:89–92.
    1. Haupt C, Alte D, Dörr M, Robinson DM, Felix SB, John U, Völzke H. The relation of exposure to shift work with atherosclerosis and myocardial infarction in a general population. Atherosclerosis. 2008;1:205–211.
    1. Romon M, Nuttens M, Fievet C, Pot P, Bard JM, Furon D, Fruchart JC. Increased triglyceride levels in shift workers. Am J Med. 1992;93:259–262.
    1. Knutsson A, Hallquist J, Reuterwall C, Theorell T, Akerstedt T. Shiftwork and myocardial infarction: a case‐control study. Occup Environ Med. 1999;56:46–50.
    1. St‐Onge MP, Grandner MA, Brown D, Conroy MB, Jean‐Louis G, Coons M, Bhatt DL; American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council . Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134:e367–e386.
    1. Crowley K, Rajaratnam S, Shea S, Epstein LJ, Czeisler CA, Lockley SW; Harvard Work Hours, Health and Safety Group . Evaluation of a single‐channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environments. J Clin Sleep Med. 2013;9:109–116.
    1. Olson R, Crain TL, Bodner TE, King R, Hammer LB, Klein LC, Erickson L, Moen P, Berkman LF, Buxton OM. A workplace intervention improves sleep: results from the randomized controlled Work, Family, and Health Study. Sleep Health. 2015;1:55–65.
    1. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi‐Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS; SAVE Investigators and Coordinators . CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375:919–931.
    1. Kim J, Stewart R, Bae K, Kang HJ, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Correlates and escitalopram treatment effects on sleep disturbance in patients with acute coronary syndrome: K‐DEPACS and EsDEPACS. Sleep. 2015;38:1105–1111.

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