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Chapter 111: Behavioral Cardiology: Epidemiology, Pathophysiology, and Clinical Management

Repeatedly, studies have found that both short and long sleep, fragmented sleep, and insomnia have been linked to an increased risk for CVD. How many hours of sleep per night characterize “short” and “long” sleep, respectively?

A. ≤ 3–4 hours; > 6–7 hours

B. ≤ 4–5 hours; > 7–8 hours

C. ≤ 5–6 hours; > 8–9 hours

D. ≤ 6–7 hours; > 9–10 hours

E. ≤ 7–8 hours; > 10–11 hours

The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 111) Poor sleep is a newer arena that has been increasingly studied for its adverse health effects. The study of sleep has included the examination of both sleep duration and the quality of sleep. The definition of short and long sleep is arbitrary, but in most studies, short sleep has been defined as ≤ 5 to 6 hours a night and long sleep as > 8 to 9 hours a night (option C). Repeatedly, studies have found that both short and long sleep, fragmented sleep, and insomnia have been linked to an increased risk for CVD. A meta-analysis of 15 studies found short sleep to be associated with a greater risk of either developing or dying from CVD (relative risk [RR], 1.48; 95% confidence interval [CI], 1.22–1.80), and a similar risk was associated with long sleep.1 Similarly, a meta-analysis of 13 prospective studies involving 122,501 subjects found that insomnia was associated with a risk ratio of 1.45 (95% CI, 1.29–1.63) for the development of CVD or cardiac events.2

A 54-year-old woman with a recent history of major depression presents to your clinic. You remember learning about the existence of an association between depression and cardiac health. Which of the following statements about this association is false?

A. Major depression is found in approximately 15% of cardiac patients

B. There is a gradient relationship between the magnitude of major depressive symptoms and the occurrence of cardiac events

C. Mild levels of depression or psychological distress are not associated with an increased risk of adverse events

D. Depression is a risk factor for cardiac events among community cohorts without pre-existing CVD

E. All of the above are false

The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 111) Major depression, which is characterized by depressed mood and/or lack of interest in nearly all activities for ≥ 2 weeks, in conjunction with at least four to five ...

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