Background Acute coronary syndrome (ACS) induces clinically significant posttraumatic stress symptoms (PTSS) in 12% of patients. Subjective sleep problems are a risk factor for the development of PTSS, but this is underexplored in patients with ACS. Purpose To examine the association of insomnia symptoms with ACS-induced PTSS. Methods In this longitudinal study with 154 patients (all white, 84.4% male, mean age 58.7 years) with a verified ACS, insomnia symptoms were interviewer assessed at hospital admission and at 3 months, using the Jenkins Sleep Scale (JSS)-4. ACS-induced PTSS were assessed with the Clinician-Administered Posttraumatic Stress Disorder Scale 3 months after hospital admission. In multivariable linear models, insomnia symptoms were regressed on PTSS, adjusting for demographics, clinical variables, health behaviors, and psychological data, including cognitive depressive symptoms. Results Greater insomnia symptoms at admission (β = .165, p = .034), greater increase in insomnia symptoms from admission to 3 months (β = .233, p = .008), and greater insomnia symptoms at 3 months (β = .239, p = .002) were independently associated with more severe total PTSS at 3 months. Concerning the individual PTSS clusters, both insomnia symptoms at admission (β = .214, p = .007) and at 3 months (β = .213, p = .012) were independently associated with reeexperiencing symptoms. Removing sleep items from PTSS scores and excluding patients on antidepressants in two sensitivity analyses did not substantially change the results. Conclusions Insomnia symptoms could play an important role in the development and severity of ACS-induced PTSS. This relationship seems not simply explained by the fact that sleeping difficulties are inherent to the phenotype of posttraumatic stress disorder. Clinical Trial information NCT01781247.

中文翻译：

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失眠症状和急性冠状动脉综合征引起的创伤后应激症状：横断面和前瞻性关联的综合分析

背景 急性冠状动脉综合征 (ACS) 在 12% 的患者中引起临床上显着的创伤后应激症状 (PTSS)。主观睡眠问题是发生 PTSS 的一个危险因素，但在 ACS 患者中这一点尚未得到充分探索。目的 研究失眠症状与 ACS 诱发的 PTSS 的关系。方法 在这项纵向研究中，154 名经过验证的 ACS 患者（全是白人，84.4% 男性，平均年龄 58.7 岁）在入院时和 3 个月时使用 Jenkins 睡眠量表 (JSS)-4 评估失眠症状。入院 3 个月后，用临床医生管理的创伤后应激障碍量表评估 ACS 引起的 PTSS。在多变量线性模型中，失眠症状在 PTSS 上回归，调整了人口统计学、临床变量、健康行为、和心理数据，包括认知抑郁症状。结果 入院时失眠症状加重（β = .165，p = .034），入院至 3 个月失眠症状增加更多（β = .233，p = .008），3 个月时失眠症状加重（β = .239, p = .002) 与 3 个月时更严重的总 PTSS 独立相关。关于个体 PTSS 集群，入院时的失眠症状 (β = .214, p = .007) 和 3 个月时的失眠症状 (β = .213, p = .012) 都与再次出现症状独立相关。在两项敏感性分析中，从 PTSS 评分中删除睡眠项目并排除服用抗抑郁药的患者并没有显着改变结果。结论 失眠症状可能在 ACS 诱发的 PTSS 的发生发展和严重程度中起重要作用。这种关系似乎不能简单地通过睡眠困难是创伤后应激障碍表型所固有的事实来解释。临床试验信息 NCT01781247。