Poor Sleep Quality Associated With High Risk Of Ventricular Tachycardia After Acute Myocardial Infarction

Abstract

Background

Sleep disorders (SDs) are usually associated with an increase in frequency of ventricular tachycardia (VT). However, the relationship between SDs and the prevalence of VT within the first week of acute myocardial infarction (AMI) remains unclear. This study aimed to evaluate their associations and potential mechanisms.

Methods

This structured questionnaire-based cross-sectional study enrolled 303 patients with AMI from a hospital in northern China. Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality of subjects. Heart rate variability (HRV) of patients was investigated by ambulatory electrocardiography recorders. Enzyme-linked immunosorbent assay was used to measure the plasma levels of catecholamine in a subgroup including 80 patients with AMI.

Results

After adjusting to basic cardiovascular characteristics, results of multivariate logistic regression demonstrated that the global PSQI score and its main components were positively associated with VT prevalence in inpatients with AMI. There were significantly different HRV parameters interpreted as autonomic nerve activity in two groups of AMI patients with different sleep quality. In addition, we found the influence of sleep quality on plasma concentrations of adrenaline and norepinephrine in AMI patients.

Conclusion

Sleep status was significantly associated with the initiation of VT within the first week of AMI, probably due to the effect of SDs on sympathetic nerve activity. Amelioration of sleep quality and sympathetic hyperactivity may be prospective strategy to curb arrhythmias after AMI.

Keywords:

• ventricular tachycardia
• acute myocardial infarction
• sleep disorders
• heart rate variability
• catecholamine

Acknowledgments

We are very grateful to Dr. Pengzhou Hang for his research assistance.

Ethics Approval

This cross-sectional study was approved by the Ethics Committee of The Second Affiliated Hospital of Harbin Medical University (ky2018-246) and all experimental procedures conformed to the ethical guidelines of the 1975 Declaration of Helsinki. All patients signed the written informed consent documents.

Abbreviations

VT, ventricular tachycardia; AMI, acute myocardial infarction; SDs, sleep disorders; VAs, ventricular arrhythmias; PSQI, Pittsburgh Sleep Quality Index; Holter, 24-h ambulatory electrocardiography; QTc, corrected QT intervals; HRV, heart rate variability; STEMI, ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; ECG, electrocardiogram; EF, ejection fraction; LVEDD, left ventricular end-diastolic internal diameter; AHR, 24 hr average heart rates; SDNN, the standard deviation of mean NN; standard deviation of all RR intervals; SDANN, the standard deviation of all 5 min mean RR intervals; rMSSD, root-mean-square of the successive RR interval difference; SDNNi, the mean of the standard deviation of all normal RR intervals for all 5-min segments; pNN50, the percentage of >50 ms differences between adjacent NN; TP, total power (sum of VLF, LF and HF); LF, low frequency power; HP, low frequency power; vLF, very low frequency power; uLF, ultra-low-frequency; LF/HF, the ratio of low to high frequency power; EDTA, ethylenediaminetetraacetic acid; IQR, interquartile range; CI, confidence interval.

Disclosure

The authors declare no conflict of interest.

Additional information

Funding

This research was supported by grants from the Health Commission Foundation of Heilongjiang Province (2018065) and the Heilongjiang Province Postdoctoral Science Foundation (LBH-Z18212).