Insónia Crónica e o seu potencial impacto no desenvolvimento de Síndrome Coronário Agudo - uma revisão sistemática

Abstract

Background: Acute Coronary Syndrome has a high incidence and is an important cause of death and morbidity at a national and European level. Chronic Insomnia might constitute a risk factor for its development, and if so, there could be a place for the inclusion of this pathology in the global primary prevention strategies, in Primary Healthcare. Method: A systematic review was conducted, searching for papers that investigated the potential impact of Chronic Insomnia on the development of Acute Coronary Syndrome, in Pubmed, Scopus and the specialized magazine SLEEP. Results: Five papers were included, involving over 900 000 individuals. The outcomes' definitions and the diagnosis criteria were different among the included studies, but all arrived at the conclusion of a statistically significative effect (totality of the population or subgroups only) before adjusting for confounding variables and, of these, four out of five arrived at the same conclusion after adjusting. Two of the studies also investigated the potential of sex as an effect modifier. Discussion: The existence of the studied association is possible. Nevertheless, it was impossible for us to conclude with certainty its veracity, due to the fact that we did not obtain an aggregated measure of outcome (differences in outcome measures and population's characteristics) and because several of the causality criteria were not fulfilled. Conclusion: There seems to be an association between Chronic Insomnia and the onset of Acute Coronary Syndrome, but there is a need for more studies to be developed, with well-established diagnosis criteria and uniform outcome measures.