September 09, 2020
Health care clinicians are collecting patient data at an increasing rate. The high rate of data collection is used to make a more informed therapeutic decision. This includes the standard SOAP note data. We have recently added Social Determinants of Health to our list of important data to collect that affects drug outcomes. Another data point to consider is that drugs affect sleep patterns. Categories of drugs that can affect sleep include anti-arrhythmics, ß-adrenergic blockers, clonidine, corticosteroids, diuretics, and some cold, cough and flu medications.1 Interestingly, we often do not ask about sleep patterns unless the patient offers this information. Many Review of Systems instruments do not include a sleep pattern question.
Sleep is an important goal for all of us and related to good health. As adults 7-9 hours of sleep a day/night is recommended.2 A quality sleep pattern follows a circadian rhythm that supports healthy brain, function and body homeostasis. Irregular sleep patterns, however, are associated with obesity and diabetes. Recently, a research team at the Brigham and Women’s Hospital studied whether an irregular sleep pattern may increase the risk of cardiovascular events.
Approximately 2000 participants 45-84 years old without a diagnosis of cardiovascular disease enrolled in a Multi-Ethnic Study of Atherosclerosis.3 Each participant completed a 7-day wrist actigraphy (a non-invasive method of monitoring human rest/activity cycles) and followed for a mean of 4.9 years. There were 111 cardiovascular events including heart attack, stroke or death. Hazard ratios for cardiovascular disease events were compared to a reference sleep duration of ≤ 60minutes. The multivariate-adjusted hazard ratio (HR) were 1.07 (95% CI: 0.61-0.88) for sleep duration of 61-90 minutes, 1.54 (95% CI: 0.89-2.65) for sleep duration of 91-120 minutes, and 2.02 (95% CI: 1.20-3.30) for sleep duration with a SD >120minutes. The conclusion was that an irregular sleep duration and timing are a new risk factor for cardiovascular disease, independent of traditional cardiovascular risk factors and sleep quantity or quality.
As we know, our sleep patterns are disturbed by stress, travel, or anxiety. If this disturbed pattern occurs over time, these above results support an increased risk for cardiovascular events, independent of underlying cardiovascular pathogenesis. Another important patient collection data is to query a patient (or significant other) about their sleep pattern, especially in patients prescribed drugs affecting sleep.
Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.
- How Medications may Affect Sleep. https://www.sleepfoundation.org/articles/how-medications-may-affect-sleep Accessed 08/2020
- Sleep Needs. https://www.helpguide.org/articles/sleep/sleep-needs-get-the-sleep-you-need.htm Accessed 08/2020
- Huang T, Mariani S, Redline S. Sleep irregularity and risk of cardiovascular events. JACC 2019;75(9) DOI: 10.1016/j/jack.2019.12.054