||Insomnia is a common complaint in general population. The association is clear between sleep disorders (SD) and comorbidities such as prior psychiatric disorders, prior circulatory diseases and prior gastrointestinal diseases. Conversely, insomnia may predispose patients to cardiovascular and cerebrovascular risk. More than 50% of stroke patients have sleep-disordered breathing, mostly in the form of obstructive sleep apnea, which is recognized as an independent risk factor for cardiovascular diseases (CVD) and cerebrovascular diseases (CVA). Gangwisch et al found that depriving healthy people of sleep acutely raises blood pressure and sympathetic nervous system activity. Prolonged short sleep durations could lead to hypertension. Recent studies have also shown insomnia to be associated with atherosclerosis risk. However, studies investigating the possibility that non-apnea SD and sleep apnea insomnia (SA) may increase cerebrovascular diseases (CVA) are scant.|
Acute myocardial infarction (AMI) results from the interruption of blood supply to a part of the heart muscle, which causes ischemia ensuing oxygen shortage, and the heart cells to be damaged or die. CVA types, including stroke, transient ischaemic attack, subarachnoid haemorrhage, vascular dementia, is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. AMI and CVA are life-threatening disorders that retain high morbidity and mortality despite advances in treatment. This thesis evaluates the effect of non-apnea SD and SA on the development of AMI and CVA among adults in Taiwan.
The thesis results are from a nationwide population-based cohort study assessing the possibilities of comparison of CVA and AMI risk among patients with SA, non-apnea SD. The original data were derived from Taiwan’s National Health Insurance Research Database (NHIRD). We conducted Cox’s proportional hazard regression analysis to estimate the effects of non-apnea sleep disorders and SA on CVA and AMI risk. Finally, The Kaplan-Meier curves are utilized to plot the freedom from AMI and CVA in both cohorts
By adjusting probable risk factors, the hazard ratio (HR) of AMI and CVA both increased with age and with comorbidity in both cohorts. After adjusting for demographic factors and comorbidities, the incidence of developing CVA increased 12% in SA patients. The Kaplan-Meier curves show that SA patients have higher chance to get AMI and CVA than the non-apnea SD patients with the time increasing.