Annals of Behavioral Medicine

, Volume 46, Issue 3, pp 349–357 | Cite as

Association of Acute Coronary Syndrome-Induced Posttraumatic Stress Disorder Symptoms with Self-Reported Sleep

  • Jonathan A. Shaffer
  • Ian M. Kronish
  • Matthew Burg
  • Lynn Clemow
  • Donald Edmondson
Original Article

Abstract

Background

Symptoms of posttraumatic stress disorder (PTSD) after acute coronary syndrome (ACS) are associated with recurrent ACS events and mortality. Poor sleep may be a mechanism, but the association between PTSD and sleep after ACS is unknown.

Purpose

This study aims to estimate the association between ACS-induced PTSD symptoms and self-reported sleep.

Methods

ACS-induced PTSD symptoms were assessed 1-month post-ACS in 188 adults using the Impact of Events Scale-Revised. Sleep was assessed using the Pittsburgh Sleep Quality Index. Linear and logistic regression models were used to determine whether PTSD symptoms were associated with self-reported sleep, independent of sociodemographic and clinical covariates.

Results

In adjusted models, ACS-induced PTSD symptoms were associated with worse overall sleep (β = 0.22, p = 0.003) and greater impairment in six of seven components of sleep (all p values <0.05).

Conclusions

ACS-induced PTSD symptoms may be associated with poor sleep, which may explain why PTSD confers increased cardiovascular risk after ACS.

Keywords

Posttraumatic stress disorder Sleep Acute coronary syndrome 

References

  1. 1.
    Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: A meta-analytic review. PLoS One. 2012;7:e38915.PubMedCrossRefGoogle Scholar
  2. 2.
    Babson KA, Feldner MT. Temporal relations between sleep problems and both traumatic event exposure and PTSD: A critical review of the empirical literature. J Anxiety Disord. 2010;24:1-15.PubMedCrossRefGoogle Scholar
  3. 3.
    Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000;41:469-478.PubMedCrossRefGoogle Scholar
  4. 4.
    Schiza SE, Simantirakis E, Bouloukaki I, et al. Sleep patterns in patients with acute coronary syndromes. Sleep Med. 2010;11:149-153.PubMedCrossRefGoogle Scholar
  5. 5.
    Schwartz SW, Cornoni-Huntley J, Cole S, Hays J, Blazer DG, Schocken DD. Are sleep complaints an independent risk factor for myocardial infarction? Ann Epidemiol. 1998;8:384-392.PubMedCrossRefGoogle Scholar
  6. 6.
    Caska CM, Hendrickson BE, Wong MH, Ali S, Neylan T, Whooley MA. Anger expression and sleep quality in patients with coronary heart disease: Findings from the Heart and Soul Study. Psychosom Med. 2009;71:280-285.PubMedCrossRefGoogle Scholar
  7. 7.
    Mundy E, Baum A. Medical disorders as a cause of psychological trauma and posttraumatic stress disorder. Curr Opin Psychiatry. 2004;17:123-127.CrossRefGoogle Scholar
  8. 8.
    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.PubMedCrossRefGoogle Scholar
  9. 9.
    Weiss D. The impact of event scale: Revised. In: Wilson JP, Tang CS, eds. Cross-cultural assessment of psychological trauma and PTSD. New York: Springer; 2007:219-238.CrossRefGoogle Scholar
  10. 10.
    First M, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV Axis I Disorders. Washington, DC: American Psychiatric Press; 1997.Google Scholar
  11. 11.
    Franklin CL, Sheeran T, Zimmerman M. Screening for trauma histories, posttraumatic stress disorders (PTSD) and subthreshold PTSD in psychiatric outpatients. Psychol Assess. 2002;14:467-471.PubMedCrossRefGoogle Scholar
  12. 12.
    Goldberg RJ, Currie K, White K, et al. Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2004;93:288-293.PubMedCrossRefGoogle Scholar
  13. 13.
    Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245-1251.PubMedCrossRefGoogle Scholar
  14. 14.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.PubMedCrossRefGoogle Scholar
  15. 15.
    Paffenbarger RS Jr, Blair SN, Lee IM, Hyde RT. Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc. 1993;25:60-70.PubMedCrossRefGoogle Scholar
  16. 16.
    Beck A, Steer R, Garbin M. Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin Psychiatry Rev. 1988;8:77-100.CrossRefGoogle Scholar
  17. 17.
    Paffenbarger RS, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978;108:161-175.PubMedGoogle Scholar
  18. 18.
    Kuppermann M, Lubeck DP, Mazonson PD, et al. Sleep problems and their correlates in a working population. J Gen Intern Med. 1995;10:25-32.PubMedCrossRefGoogle Scholar
  19. 19.
    Germain A, Buysse DJ, Shear MK, Fayyad R, Austin C. Clinical correlates of poor sleep quality in posttraumatic stress disorder. J Trauma Stress. 2004;17:477-484.PubMedCrossRefGoogle Scholar
  20. 20.
    Sanchez-Ortuno MM, Edinger JD. Cognitive-behavioral therapy for the management of insomnia comorbid with mental disorders. Curr Psychiatry Rep. 2012;14:519-528.PubMedCrossRefGoogle Scholar
  21. 21.
    Lichstein KL. Secondary insomnia: A myth dismissed. Sleep Med Rev. 2006;10:3-5.PubMedCrossRefGoogle Scholar
  22. 22.
    Blechert J, Michael T, Grossman P, Lajtman M, Wilhelm FH. Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder. Psychosom Med. 2007;69:935-943.PubMedCrossRefGoogle Scholar
  23. 23.
    Yang AC, Tsai S-J, Yang C-H, Kuo C-H, Chen T-J, Hong C-J. Reduced physiologic complexity is associated with poor sleep in patients with major depression and primary insomnia. J Affect Disord. 2011;131:179-185.PubMedCrossRefGoogle Scholar
  24. 24.
    Lijmer JG, Bossuyt PMM, Heisterkamp SH. Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med. 2002;21:1525-1537.PubMedCrossRefGoogle Scholar
  25. 25.
    Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and depression in postpartum women: A population-based study. Sleep. 2009;32:847-855.PubMedGoogle Scholar
  26. 26.
    Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry. 2005;66:1254-1269.PubMedCrossRefGoogle Scholar
  27. 27.
    Knutson KL, Spiegel K, Penev P, Cauter EV. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11:163-178.PubMedCrossRefGoogle Scholar
  28. 28.
    Voderholzer U, Al-Shajlawi A, Weske G, Feige B, Riemann D. Are there gender differences in objective and subjective sleep measures? A study of insomniacs and healthy controls. Depress Anxiety. 2003;17:162-172.PubMedCrossRefGoogle Scholar
  29. 29.
    Loredo JS, Soler X, Bardwell W, Ancoli-Israel S, Dimsdale JE, Palinkas LA. Sleep health in U.S. Hispanic population. Sleep. 2007;33:962-967.Google Scholar
  30. 30.
    Koren D, Arnon I, Lavie P, Klein E. Sleep complaints as early predictors of posttraumatic stress disorder: A 1-year prospective study of injured survivors of motor vehicle accidents. Am J Psychiatry. 2002;159:855-857.PubMedCrossRefGoogle Scholar
  31. 31.
    Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale—Revised. Behav Res Ther. 2003;41:1489-1496.PubMedCrossRefGoogle Scholar
  32. 32.
    Shemesh E, Yehuda R, Milo O, et al. Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction. Psychosom Med. 2004;66:521-526.PubMedCrossRefGoogle Scholar
  33. 33.
    Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008;118:1768-1775.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  • Jonathan A. Shaffer
    • 1
  • Ian M. Kronish
    • 1
  • Matthew Burg
    • 1
    • 2
  • Lynn Clemow
    • 1
    • 3
  • Donald Edmondson
    • 1
  1. 1.Center for Behavioral Cardiovascular HealthColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Internal MedicineYale UniversityNew HavenUSA
  3. 3.Department of Family Medicine and Community HealthRobert Wood Johnson Medical School, University of Medicine and DentistryNew BrunswickUSA

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