Sleep Quality of Patients with Myocardial Infarction in Two Diabetic and Non-diabetic Groups

Background and Objectives Poor sleep quality is common among patients with diabetes. It has destructive effects on physical and mental health as well as quality of life. This study was conducted with the aim of investigating the sleep quality of patients with myocardial infarction in two diabetic and non-diabetic groups. Subjects and Methods This descriptive and analytical study was conducted in 1402. 282 patients with myocardial infarction were included in the study as available. The data collection tool was a demographic information and standard sleep quality questionnaire. The data was analyzed in SPSS version 26 using descriptive and analytical statistics. The significance level of the tests in this study was evaluated with P<0.05. Results The mean and standard deviation of age in diabetic group patients was 58.19±10.02. The type of myocardial infarction (p=0.3) and the level of education (p=0.2) were not significantly different between the two groups. The results of the Mann-Whitney test showed that the subjective sleep quality, sleep latency, daytime dysfunction, and the overall sleep score in the two diabetic and non-diabetic groups had statistically significant differences (p-value <0.05). Conclusion The results of this study showed that the subjective sleep quality, sleep latency, daytime dysfunction and overall sleep score of patients with myocardial infarction were different in diabetic and non-diabetic groups. Therefore, it is recommended to create appropriate strategies to improve the treatment of these patients and effective training on improving their sleep quality.


Extended Abstract
Introduction iabetes mellitus is a growing public health concern worldwide.In 2021, the International Diabetes Federation reported that approximately 537 million people were living with diabetes.According to national surveys in Iran, the prevalence of diabetes was estimated to be around 10-15% and pre-diabetes to be around 25-31%.Diabetes is a known risk factor for cardiovascular disease, which is the leading cause of death worldwide.More particularly, diabetes is an important risk factor for adverse outcomes following acute myocardial infarction.Studies have shown that older age, female gender, high body mass index, poor blood sugar control, longer duration of diabetes, diabetes complications, and psychological factors increase the risk of poor sleep quality in diabetic patients.In addition, poor sleep quality is common among patients with diabetes.It has destructive effects on physical and mental health as well as quality of life.
Sleep is a period of physical and mental rest for the body and an essential human need that is vital for good health and quality of life.However, sleep disorders, environmental disturbances, as well as mood disorders negatively affect sleep quality.In Iran, especially in Guilan province, little information has been reported about the sleep quality of myocardial infarction patients who suffer from diabetes and those who do not.Since the quality and duration of sleep in patients with myocardial infarction can be improved, this study was intended to devise the necessary plans for secondary prevention by examining and knowing the influential factors in Guilan province.Therefore, this study identified the prevalence of poor sleep quality in patients with myocardial infarction in both diabetic and non-diabetic groups.

Methods
This descriptive-analytical study which was conducted in 2023 included 282 myocardial infarction patients referring to Dr. Heshmat Hospital in Rasht who were selected using the convenience sampling method.They were examined after informed consent was obtained.Patients younger than 18 years old who suffered from dementia, cognitive impairment, or any incurable disease or had a life expectancy of less than 1 year were excluded.According to the definition of ESC 2018, myocardial infarction refers to high troponin c along with at least one of the following symptoms: 1. Presence of signs of cardiac ischemia 2. New changes indicating ischemia in ECG 3. Presence of a pathological q wave in ECG 4. The presence of imaging findings based on the recent destruction of the heart myocardium or regional abnormalities in the movement of the heart wall is justified by an ischemic cause.5. Finding a clot in the coronary arteries of the heart in angiography or autopsy.After consent was obtained from the samples, two questionnaire forms were used to collect information, namely a demographic information questionnaire and the Pittsburgh Sleep Quality Index (PSQI).
The PSQI is one of the best tools for sleep quality measurement developed by Dr. Buysse

Results
In this study, 46.7% of patients in the diabetic group and 68.2% in the non-diabetic group were male.The mean ± standard deviation of age in diabetic group patients was 58.19 ± 10.02.There was no significant difference between the two groups in terms of age distribution (P=0.2).As far as marital status was concerned, 83.3% of diabetic patients and 93.2% of their non-diabetic counterparts were married.With regard to the type of myocardial infarction (P=0.3) and the level of education (P=0.2),there was no significant difference between the two groups.The results of the Mann-Whitney test showed that the subjective sleep quality, sleep latency, daytime dysfunction, and overall sleep score in the diabetic and non-diabetic groups had a statistically significant difference (P<0.05).

Conclusion
Diabetes is one of the common metabolic diseases that has a negative effect on patients' quality of life and sleep, and it has no definitive treatment.The quality of sleep as part of the quality of life is the most important indicator for evaluating the healthcare and treatment status of chronic diseases, including diabetes.One of the main goals in the treatment of diabetic patients is to improve the quality of sleep and ultimately the quality of people's lives so that they can experience a normal life.This study investigated the sleep quality of patients with myocardial infarction in diabetic and non-diabetic groups.The results of the Mann-Whitney statistical test showed that the mental quality of sleep, delay in falling asleep, daily functional disorders, and overall sleep score had significant statistical differences in the diabetic and non-diabetic groups, which is consistent with the results of Barakat et and his colleagues at the Pittsburgh Psychiatric Institute in 1989.The internal consistency of the questionnaire was verified by obtaining a Cronbach's alpha of 0.83.In 2012, Farhi et al.'s calculated validity and reliability values of this questionnaire were 0.54 and 0.77, respectively.This questionnaire originally had 9 items, but since Question 5 contains 10 sub-items, the whole questionnaire has 19 items, which are scored on a 4-point Likert scale from 0 to 3. PSQI has 7 subscales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.The data was analyzed in SPSS version 26.Descriptive statistics (mean, quartile deviation) and Mann-Whitney test were used to describe and classify the data to compare the sleep quality of patients with myocardial infarction in two diabetic and non-diabetic groups.