Existe relação entre qualidade de sono e os desfechos da reabilitação cardíaca?

Abstract

Introduction: sleep is a neurobehavioral state that plays a critical role in promoting health, with sleep quality being one of the metrics used to evaluate it. Sleep disorders are common in people with cardiovascular disease (CVD), and may precede and/or be exacerbated by a cardiac event. Cardiac rehabilitation (CR) is an intervention recommended for individuals with CVD, but it does not routinely consider aspects of sleep in this rehabilitation process. Objective: to analyze whether self-reported sleep quality interferes with the outcomes achieved in CR. Methodology: longitudinal study, carried out from June 2023 to April 2024 at the Federal University of Ceará (UFC), in Fortaleza, Ceará. Individuals with heart disease entering the CR program were assessed regarding self-reported sleep quality using the Pittsburgh Sleep Quality Index (PSQI) instrument, functionality using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) instrument, functional capacity using the 6-minute walk test (6MWT) and cardiac autonomic modulation through the acquisition of electrocardiographic signals (Olimex EKG-EMG biosensor®) to measure heart rate variability (HRV). They subsequently participated in 16 physical exercise sessions comprising aerobic and strength exercises lasting 60 minutes each session, twice a week on fixed days. For statistical analysis, the Shapiro-Wilk test, intragroup analysis, Wilcoxon test for paired samples, Spearman correlation and linear regression were performed, with the pre-intervention PSQI global score considered as an independent variable. Results: the final sample consisted of 25 participants (12 women and 13 men; mean age 60 ± 8 years). After completing the CR program, there was a significant improvement in functional capacity (6MWT), sleep quality as well as functionality in general, with emphasis on the domains of cognition and participation. In contrast, no HRV metric in the frequency domain showed significant change with the CR program. Furthermore, the results showed that changes in the “cognition” domain of WHODAS 2.0 have a moderate and negative relationship with pre-CR sleep quality. Regarding HRV metrics, pre-CR sleep quality showed a moderate but negative correlation with LF/HF with the individual in the supine position. Finally, it was observed that the greatest influence of sleep occurs on the functional outcome. Conclusion: impaired sleep quality negatively influences the modulation of cognition and cardiac autonomic function in subjects undergoing CR, and may indicate the presence of sleep disorders that require adequate diagnosis and treatment combined with CR.