The results of screening for main sleep disorders in patients with myocardial infarction at the hospital stage

Introduction. Insomnia and syndrome of obstructive sleep apnea (SOAS) are the two most important sleep disorders, which increase the risk of development and progression of myocardial infarction (MI), but are very poorly diagnosed in clinical practice. Aim. To determine the frequency, structure of major sleep disorders and their relationship with the course of MI.

Materials and methods. The study included 34 people with MI at the inpatient stage of rehabilitation, who were examined in accordance with clinical recommendations, a detailed survey and questionnaire on the Pittsburgh scale modified by Ya.I. Levin were performed to detect insomnia, a STOP-BANG scale was used to assess the risk of SOAS.

Results. 22 men (64.7%) and 12 women (35.3%) with MI were examined. The age median was 63.5 (LQ = 56; UQ = 69) years. Initially, complaints of sleep disturbances were registered in 16 (47%) people; based on the results of a detailed questioning, 27 (79.4%) respondents already noted symptoms of insomnia. The frequency of insomnia with obvious and borderline sleep disorders determined due to Levin’s form amounted to 67.7%. Insomnia was significantly more common in women than in men. Medium and high risk of SOAS was identified in 58.8% and 23.5% of individuals, accordingly. Sleep duration was positively correlated with Simpson ejection fraction (r = 0.41) and hemoglobin concentration (r = 0.38). A relationship was identified between the values on the STOP BANG scale and body mass index (r = 0.37), waist circumference (r = 0.44), and leukocyte level (r = -0.36). Scores determined by the STOP BANG scale were higher in the group of patients with MI without ST elevation (Zadj. = -2.1; p = 0.037).

Conclusions. Insomnia and a high risk of SOAS in patients with MI are more common than in the population and affect the course of MI, so it is important to promptly identify and correct these conditions.

1. Grandner MA. Sleep, Health, and Society. Sleep Med Clin. 2017;12(1):1–22. https://doi.org/10.1016/j.jsmc.2016.10.012.

2. Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol. 2018;175(16):3190–3199. https://doi.org/10.1111/bph.14116.

3. Belloir J, Makarem N, Shechter A. Sleep and Circadian Disturbance in Cardiovascular Risk. Curr Cardiol Rep. 2022;24(12):2097–2107. https://doi.org/10.1007/s11886-022-01816-z.

4. Benz F, Meneo D, Baglioni Ch, Hertenstein E. Insomnia symptoms as risk factor for somatic disorders: An umbrella review of systematic reviews and meta-analyses. J Sleep Res. 2023;32(6):e13984. https://doi.org/10.1111/jsr.13984.

5. Jarrin DC, Ivers H, Lamy M, Chen IY, Harvey AG, Morin ChM. Cardiovascular autonomic dysfunction in insomnia patients with objective short sleep duration. J Sleep Res. 2018;27(3):e12663. https://doi.org/10.1111/jsr.12663.

6. Grandner MA, Alfonso-Miller P, Fernandez-Mendoza J, Shetty S, Shenoy S, Combs D. Sleep: important considerations for the prevention of cardiovascular disease. Curr Opin Cardiol. 2016;31(5):551–565. https://doi.org/10.1097/HCO.0000000000000324.

7. Ali E, Shaikh A, Yasmin F, Sughra F, Sheikh A, Owais R et al. Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data. PLoS ONE. 2023;18(9):e0291859. https://doi.org/10.1371/journal.pone.0291859.

8. Medvedev VE, Kotova OV, Akarachkova ES, Belyaev AA. Insomnia in psychiatry and general medicine: the structure of the disorder and modern methods of therapy. Sovremennaya Terapiya v Psikhiatrii i Nevrologii. 2024;(1):34–40. (In Russ.) Available at: https://www.elibrary.ru/rzoqwi.

9. Chattu VK, Manzar D, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare. 2018;7(1):1. https://doi.org/10.3390/healthcare7010001.

10. Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest. 2017;152(2):435–444. https://doi.org/10.1016/j.chest.2017.01.026.

11. Uwishema O, Nazir A, Munyangaju I, Shariff S, Komi OA, Chibueze N, Wojtara M. The pulse of sleep: novel interventions in understanding the sleep-cardiovascular connection: a literature review. Ann Med Surg. 2024;86(9):5283–5291. https://doi.org/10.1097/MS9.0000000000002414.

12. Zhang L, Li G, Bao Ya, Liu M. Role of sleep disorders in patients with cardiovascular disease: A systematic review. Int J Cardiol Cardiovasc Risk Prev. 2024;8:21:200257. https://doi.org/10.1016/j.ijcrp.2024.200257.

13. Belloir J, Makarem N, Shechter A. Sleep and Circadian Disturbance in Cardiovascular Risk. Curr Cardiol Rep. 2022;24(12):2097–2107. https://doi.org/10.1007/s11886-022-01816-z.

14. Pizova NV. Insomnia: definition, prevalence, health risks and therapy approaches. Meditsinskiy Sovet. 2023;17(3):85–93. (In Russ.) https://doi.org/10.21518/ms2023-034.

15. Pizova NV, Pizov AV, Solovyov IN. Insomnia: risk factors, sexand agespecific features, and therapeutic approaches. Meditsinskiy Sovet. 2022;16(11):62–70. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-11-62-70.

16. Tyurin VP, Savchuk ОV, Proskurnova VV, Dobrikov EA, Kulagina AM. Obstructive sleep apnea as an independent predictor of cardiovascular mortality. Bulletin of Pirogov National Medical & Surgical Center. 2020;15(2):126–128. (In Russ.) https://doi.org/10.25881/BPNMSC.2020.95.30.022.

17. McDermott M, Brown DL, Chervin RD. Sleep disorders and the risk of stroke. Expert Rev Neurother. 2018;18(7):523–531. https://doi.org/10.1080/14737175.2018.1489239.

18. Ravichandran R, Gupta L, Singh M, Nag A, Thomas J, Panjiyar BK. The Interplay Between Sleep Disorders and Cardiovascular Diseases: A Systematic Review. Cureus. 2023;15(9):e45898. https://doi.org/10.7759/cureus.45898.

19. Wipper B, Mayer-Suess L, Cesari M, Ibrahim A, Winkelman J, Kiechl S. Relationship of Suboptimal and Disordered Sleep with Cardiovascular Disease and Its Risk Factors – A Narrtive Review. Neuroepidemiology. 2025;59(2):176–192. https://doi.org/10.1159/000539369.

20. Liu D, Yu Ch, Huang K, Thomas Sh, Yang W, Liu S, Kuang J. The Association between Hypertension and Insomnia: A Bidirectional Meta-Analysis of Prospective Cohort Studies. Int J Hypertens. 2022;2022:4476905. https://doi.org/10.1155/2022/4476905.

21. Conley S, Jeon S, Breazeale S, O’Connell M, Hollenbeak ChS, Jacoby D et al. Symptom Cluster Profiles Among Adults with Insomnia and Heart Failure. Behav Sleep Med. 2023;21(2):150–161. https://doi.org/10.1080/15402002.2022.2060226.

22. Golskaya AI, Mirzoeva RK, Chernik OV, Osipova AS, Berdysh DS. Sleep disorders and the main causes of insomnia. International Research Journal. 2021;106(4):108–112. (In Russ.) https://doi.org/10.23670/IRJ.2021.106.4.046.

23. Petrov AG, Abramov NV, Filimonov SN, Semenikhin VA. Relevance and role of risk factors in the development of myocardial infarction in the population of Kuzbass. Medicine in Kuzbass. 2021;(2):13–19. (In Russ.) https://doi.org/10.24411/2687-0053-2021-10015.

24. Miller MA, Howarth NE. Sleep and cardiovascular disease. Emerg Top Life Sci. 2023;7(5):457–466. https://doi.org/10.1042/ETLS20230111.

25. Dean YE, Shebl MA, Rouzan SS, Bamousa BAA, Talat NE, Ansari SA et al. Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis. Clin Cardiol. 2023;46(4):376–385. https://doi.org/10.1002/clc.23984.

26. Evlampieva LG, Yaroslavskaya EI, Kharats VE. Relationships between obstructive sleep apnea syndrome and cardiovascular risk factors. The Siberian Journal of Clinical and Experimental Medicine. 2021;36(1):58–65. (In Russ.) https://doi.org/10.29001/2073-8552-2021-36-1-58-65.

27. Mao Zh, Zheng P, Zhu X, Wang L, Zhang F, Liu H et al. Obstructive sleep apnea hypopnea syndrome and vascular lesions: An update on what we currently know. Sleep Med. 2024;119:296–311. https://doi.org/10.1016/j.sleep.2024.05.010.

28. Surikova NA, Glukhova AS. Obstructive sleep apnea syndrome: literature review. Cardiosomatics. 2023;14(1):67–76. (In Russ.) https://doi.org/10.17816/CS321374.

29. Yeghiazarians Ye, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;144(3):e56–e67. https://doi.org/10.1161/CIR.0000000000000988.

30. DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med. 2024;13(11):3223. https://doi.org/10.3390/jcm13113223.

31. Suen C, Wong J, Ryan CM, Goh S, Got T, Chaudhry R et al. Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review. J Clin Med. 2020;9(4):989. https://doi.org/10.3390/jcm9040989.

32. Zharikova AV, Krivoshej OA, Zharikova AO, Ananchenko OI. Possibilities of diagnosis of obstructive sleep apnea syndrome. Medical and Biological Problems of Life Activity. 2022;27(1):69–79. (In Russ.) Available at: https://medbio.ejournal.by/jour/article/view/127.

33. Omelchenko MYu. Non-steroidal anti-inflammatory drugs in practice of cardiologist: choice of drug. Medical Alphabet. 2020;(28):22–26. (In Russ.) https://doi.org/10.33667/2078-5631-2020-28-22-26.

34. Xiang L, Cheng YP, Wang J, Wu YN, Chen R. Effects of obstructive sleep apnea syndrome on myocardial work and prognosis in patients with acute myocardial infarction. Zhonghua Yi Xue Za Zhi. 2023;103(48):3946–3953. https://doi.org/10.3760/cma.j.cn112137-20230401-00525.

35. Yang Sh, Xing Yo, Wang Z, Liu Ya, Chen H, Ren Ya et al. Association of Obstructive Sleep Apnea With the Risk of Repeat Adverse Cardiovascular Events in Patients With Newly Diagnosed Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Ear Nose Throat J. 2021;100(4):260–270. https://doi.org/10.1177/0145561321989450.

36. Chen Ya, Chen Yi, Wen F, He Zh, Niu W, Ren Ch et al. Does continuous positive airway pressure therapy benefit patients with coronary artery disease and obstructive sleep apnea? A systematic review and meta-analysis. Clin Cardiol. 2021;44(8):1041–1049. https://doi.org/10.1002/clc.23669.

37. Peracaula M, Torres D, Poyatos P, Luque N, Rojas E, Obrador A et al. Endothelial Dysfunction and Cardiovascular Risk in Obstructive Sleep Apnea: A Review Article. Life. 2022;12(4):537. https://doi.org/10.3390/life12040537.

38. Gumenyuk LN, Olshevskaya NS, Isaeva AV, Kalinkina YuV. Insomnia in patients with ichemic heart disease. Naukosfera. 2023;(4-1):32–35. (In Russ.) Available at: https://elibrary.ru/xwfvyq.

39. Satueva EYa, Karoli NA. Sleep disturbances in patients with acute coronary syndrome. Bulletin of Medical Internet Conferences. 2017;7(1):428. (In Russ.) Available at: https://medconfer.com/files/archive/Bulletin-of-MIC-2017-01.pdf.

40. Hwang M, Zhang K, Nagappa M, Saripella A, Englesakis M, Chung F. BMJ Open Respir Res. 2021;8(1):e000848. https://doi.org/10.1136/bmjresp-2020-000848.

41. Bernhardt L, Brady EM, Freeman SC, Polmann H, Réus JC, Flores-Mir C et al. Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis. Sleep Breath. 2022;26(3):1053–1078. https://doi.org/10.1007/s11325-021-02450-9.