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Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease

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Abstract

Background

Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.

Purpose

This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.

Methods

Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3 ± 14.3 years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6 ± 13.0 years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.

Results

Poor sleep quality (PSQI > 5) was reported in all comorbid DCP (PSQI 12.00 ± 3.53, BDI 17.86 ± 4.28), in 60% of the 80 non-DCP (PSQI 5.59 ± 3.73, BDI 4.47 ± 3.07), and in 86.4% of the DP (PSQI 11.76 ± 4.77, BDI 27.11 ± 10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r = 0.40) and daytime dysfunction (r = 0.34). Both sleep components were significant predictors of self-rated depression (R² = 0.404).

Conclusions

Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.

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Acknowledgements

We thank the Departments of Psychiatry and Cardiology of the Technical University Hospital (Aachen), the Alexianer Hospital (Aachen) and the EOS Hospital (Münster), Germany, for recruiting patients for this study.

Declaration of Conflicting Interests

The authors declare that there were no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, Alexandrinenstrasse 1, 44791, Bochum, Germany

    Christine Norra

  2. Institute of Medical Psychology and Medical Sociology, Technical University Hospital, Aachen, Germany

    Julia Kummer, Maren Boecker, Siegfried Gauggel & Thomas Forkmann

  3. Department of Cardiology, Technical University Hospital, Aachen, Germany

    Erik Skobel & Patrick Schauerte

  4. University of Education, Freiburg, Germany

    Markus Wirtz

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  1. Christine Norra
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  2. Julia Kummer
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Correspondence to Christine Norra.

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Norra, C., Kummer, J., Boecker, M. et al. Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease. Int.J. Behav. Med. 19, 526–534 (2012). https://doi.org/10.1007/s12529-011-9205-2

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