Handbook of Sleep Disorders in Medical Conditions

Josee Savard,Marie-Christine Ouellet

• Publisher: Academic Press
• Year: 2019
• ISBN:
  9780128130155
• Topic: Psychology
• Subtopic: Neuropsychology
• Index: Psychology

Handbook of Sleep Disorders in Medical Conditions reviews the current knowledge on the nature and manifestations of sleep disorders associated with a variety of common medical conditions, including epilepsy, traumatic brain injury and dementia. It also provides clinical guidelines on how to assess and treat them with pharmacological and non-pharmacological interventions. Although the general principles of sleep medicine may be applied to some extent to patients with comorbid medical conditions, this book makes the case that an adaptive approach is warranted when considering the particularities of each condition.

In addition, clinicians must also be cautious when prescribing sleep medications as some pharmacological agents are known to exacerbate symptoms associated with the medical condition, such as cognitive deficits (i.e. difficulties with memory and attention) in cancer patients experiencing chemo brain, or in persons with neurologic conditions (e.g. mild cognitive impairment, dementia, stroke, brain injury). A differential approach to evaluating and treating sleep is thus warranted.

• 2020 PROSE Awards - Winner: Category: Textbook/Medicine and Clinical Science: Association of American Publishers
• Presents a general overview on assessing and treating sleep disorders that are applicable to a diverse set of patients
• Provides a comprehensive, up-to-date review of the literature on the prevalence and manifestations of sleep problems related to specific medical conditions
• Includes practical information regarding special considerations for the assessment and treatment of sleep issues in specific medical conditions
• 2020 PROSE Award Subject Winner in Textbook/Medicine and Clinical Science (Association of American Publishers)

Section II

Sleep Disorders in Specific Medical Conditions

Outline

• Chapter 5 Cardiovascular Disease
• Chapter 6 Lung Diseases
• Chapter 7 Obesity, Diabetes, and Metabolic Syndrome
• Chapter 8 Cancer
• Chapter 9 Chronic Pain
• Chapter 10 Traumatic Brain Injury
• Chapter 11 Mild Cognitive Impairment and Dementia
• Chapter 12 Stroke
• Chapter 13 Human Immunodeficiency Virus/AIDS
• Chapter 14 Inflammatory Arthropathies
• Chapter 15 Chronic Fatigue Syndrome and Fibromyalgia
• Chapter 16 Multiple Sclerosis
• Chapter 17 Gastrointestinal Disorders
• Chapter 18 Sleep in Pediatric Patients
• Chapter 19 Sleep in Hospitalized Patients

Chapter 5

Cardiovascular Disease

Nancy S. Redeker, Beatrice Renfield Term Professor of Nursing, Yale University School of Nursing, West Haven, CT, United States

Abstract

Cardiovascular disease (CVD) is a major cause of morbidity, mortality, and poor quality of life throughout the world. Recent evidence suggests that sleep deficiency, including short or long sleep duration, insomnia and poor sleep quality, sleep-disordered breathing, and restless legs syndrome contribute to the development of CVD. Adults who are living with chronic CVD also experience significant sleep deficiency that may worsen daytime symptoms, function, and quality of life and contribute to disease exacerbation, morbidity, mortality, and excess health-care utilization. In this chapter, we review the evidence for the contributions of sleep deficiency to CVD and discuss the implications for population health and clinical interventions to address sleep deficiency among people with CVD, including hypertension, coronary heart disease, and heart failure.

Keywords

Cardiovascular disease; hypertension; heart failure; dysrhythmias; atrial fibrillation; stroke; sleep apnea; insomnia; sleep; sleep disorders

Outline

• Introduction 100
• Contributions of Sleep Deficiency to the Development of Cardiovascular Disease 100
  • Sleep Duration 100
  • Insomnia and Sleep Quality 102
  • Obstructive Sleep Apnea 104
  • Restless Legs Syndrome 104
  • Comorbid Sleep Disorders 105
• Sleep Disorders and Sleep Deficiency Among Adults With Chronic Cardiovascular Disease 105
• Consequences of Sleep Deficiency and Sleep Disorders in People With Chronic Cardiovascular Disease 107
• Assessment of Sleep Disturbance in People With or At-Risk for Cardiovascular Disease 108
• Interventions to Improve Sleep Impairments in People With or At-Risk for Cardiovascular Disease 109
  • Population-Based Approaches 109
  • Clinical Approaches Targeting Sleep to Reduce Cardiovascular Disease Risk and Outcomes in People With Chronic Cardiovascular Disease 110
  • Treatment of Sleep-Disordered Breathing 111
• Areas for Future Research 112
• Clinical Vignette 113
• Conclusions 113
• References 114

Introduction

Cardiovascular disease (CVD) leads to approximately 32% of annual deaths worldwide, and coronary heart disease (CHD) and stroke are the primary contributors.¹ The worldwide costs of CVD treatment are currently about $863 billion and expected to rise to $1044 billion by the year 2030.² CVD, including CHD, stroke, heart failure (HF), hypertension, and dysrhythmias, also contributes to excessive morbidity, poor quality of life, and functional performance. Several known risk factors (e.g., diet, lack of physical activity, and obesity) contribute to the development and exacerbation of these conditions, but recent epidemiological, experiwmental, and clinical evidence suggests that sleep deficiency, including shorter or longer than normative sleep, poor sleep quality, fragmentation, and timing, and specific sleep disorders [e.g., sleep apnea, insomnia, and restless legs syndrome (RLS)] may also contribute to the development of these conditions. For people who already have chronic CVD, sleep deficiency may contribute to exacerbation of disease and increased risk of death, health-care utilization, and symptom burden and decrements in functional performance and quality of life.

At least 70 million US-Americans³ and many others throughout the world experience sleep deficiency, a multifactorial phenomenon influenced by behavioral, environmental, and health factors, as well as intrinsic sleep disorders. In this chapter, we address the extent to which sleep deficiency/sleep disorders contribute to CVD, the nature and consequences of sleep deficiency/sleep disorders across the trajectory of chronic CVD conditions, and the role of population health and clinical interventions focused on addressing the cardiovascular and related outcomes of sleep deficiency. Given the multidimensional nature of sleep deficiency (e.g., duration, perceived sleep quality/insomnia symptoms, and specific sleep disorders), the variable contributions of these attributes to CVD, and the need for specific sleep interventions that focus on these attributes, we address each of these characteristics of sleep in relationship to CVD in the following narrative.

Contributions of Sleep Deficiency to the Development of Cardiovascular Disease

Sleep Duration

Experts recommend that adults receive 7 or more hours of sleep each night.⁴ However, approximately one-third of adults in western countries do not meet this goal⁵ and may, therefore, be at high risk for negative cardiovascular consequences including hypertension, CHD, dysrhythmias, HF, stroke,⁶ and excessive CVD-related mortality.^7,8

There is growing evidence that short sleep duration and, in some cases, prolonged sleep duration⁹ may contribute to CVD. A metaanalysis of prospective cohort studies of adults with at least 1-year follow-up revealed associations between short sleep duration and risk of hypertension, with a closer association with objectively measured [RR=1.24 (1.04–1.49)], compared to self-reported blood pressure [RR=1.11 (0.79–1.57)].¹⁰ Another review revealed a 17% increased risk of hypertension for adults with short sleep,⁷ and short sleep duration modified the relationship between hypertension and all-cause mortality.¹¹ Studies that experimentally shortened sleep documented acute changes in nocturnal systolic and diastolic blood pressure, as well as heart rate,^12,13 although data are sometimes conflicting.

Cross-sectional studies suggest that long sleep duration (9 hours or longer) may also contribute to hypertension, but researchers did not find consistent associations in longitudinal studies.¹⁴ However, a recent systematic review revealed no association between long sleep duration and hypertension,⁹ despite its associations with CVD mortality.

Both short and long sleep were associated with CHD^7,15 and incident cardiac events in women who had CHD at baseline, after controlling for relevant covariates in the Nurses’ Health Study. The highest relative risks were for those with 5 or fewer hours of sleep and those with 9 or more hours of sleep,¹⁶ while a metaanalysis revealed a 23% increased risk of CHD with short sleep duration among studies with at least 1-year follow-up. A systematic review of studies that had at least 3-year follow-up revealed associations between both short and long sleep duration, incident CHD, and death from CHD, while short sleep duration was associated with particularly high risk of incident HF¹⁷ and atrial fibrillation.¹⁸

Together, these studies suggest that short sleep duration increases the risk of CVD, primarily hypertension, and CHD. Although there is consistent evidence of associations between either short or long sleep duration or a U-shaped relationship with selected CVD conditions, these associations may be stronger in subsets of the population. For example, the relationship between sleep duration and hypertension seems to be higher among young and middle-aged adults than in older adults,^7,19 and there are likely sex²⁰ and race-related differences in this relationship. For example, black people with resistant hypertension showed a twofold increased rate of short sleep duration,²¹ compared to whites. Further research is needed to determine the groups who incur the high...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of Contributors
• Preface
• Section I: General Issues
• Section II: Sleep Disorders in Specific Medical Conditions
• Index