Anxiety, depression, sleep disorder, and coronary microvascular dysfunction in angina with non-obstructive coronary...

Coronary microvascular dysfunction (CMD) is a key mechanism in angina with nonobstructivecoronary arteries (ANOCA). While psychological stress affects cardiovascular health,the link between specific psychological symptoms and CMD in ANOCA patients remains unclear.

This study aimed to investigate the association of anxiety, depression, and sleep disorder with CMD assessed by invasive coronary physiology in ANOCA patients.

A total of 102 ANOCA patients underwent coronary angiography and invasive coronary function testing including thermodilution-derived index of microcirculatory resistance (IMR) andcoronary flow reserve. CMD was defined as coronary flow reserve <2.5 or IMR ≥25. Anxiety, depression,and sleep quality were assessed using the Generalized Anxiety Disorder-7, Patient HealthQuestionnaire-9, Pittsburgh Sleep Quality Index scales, respectively.

Among the 102 enrolled ANOCA patients, 50.0% exhibited anxiety symptoms, 30.4%showed depression symptoms, and 67.6% reported sleep disorders. Patients with abnormal IMR hadsignificantly higher prevalence of anxiety (72.9% vs. 29.6%; P <0.001), depression (43.8% vs. 18.5%;P = 0.009), and sleep disorders (81.2% vs. 55.6%; P = 0.006) than those without. Multivariable analysisidentified anxiety as an independent predictor of CMD with abnormal IMR (odds ratio, 4.84; 95%confidence interval, 1.98-12.36; P <0.001). For CMD defined by abnormal coronary flow reserve, sleepdisorder showed a borderline association. Restricted cubic spline analyses showed that dose-dependentCMD risk increases with worsening psychological symptoms, especially for IMR-defined CMD.

Anxiety, depression, and sleep disorders are prevalent and dose-dependently associatedwith CMD in ANOCA, particularly elevated IMR.