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Volume 15 No. 03
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Accepted Papers

Review Articles

Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review

Michael Tilling Madsen, MD, PhD1,2; Chenxi Huang, MD1; Graziella Zangger, MHS3; Ann Dorthe Olsen Zwisler, MD, PhD3; Ismail Gögenur, MD, DMSc1
1Center for Surgical Science, Zealand University Hospital, Denmark; 2Department of Emergency, Zealand University Hospital, Denmark; 3REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark

Study Objectives:

Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD.


A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence.


Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited.


Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted.

Systematic Review Registration:

Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL:


Madsen MT, Huang C, Zangger G, Zwisler AD, Gögenur I. Sleep disturbances in patients with coronary heart disease: a systematic review. J Clin Sleep Med. 2019;15(3):489–504.

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