Chest pain at night
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Nighttime Chest Pain: Risks and Associations
Increased Risk of Acute Coronary Syndrome (ACS) at Night
Higher ACS Risk During Nighttime Hours
Research indicates that individuals experiencing chest discomfort at night are at a significantly higher risk of acute coronary syndrome (ACS). A study analyzing 1,655 telephone triage recordings found that the risk of ACS was almost twice as high for calls made between midnight and 9 am compared to other times of the day. This risk was particularly pronounced in men, with a crude risk ratio of 2.33, compared to 1.29 in women . The adjusted risk ratio for ACS at night was 1.82, suggesting that healthcare providers should consider dispatching ambulances more promptly for nighttime chest discomfort .
Obstructive Sleep Apnea (OSA) and Myocardial Infarction (MI)
Patients with obstructive sleep apnea (OSA) are also at a higher risk of experiencing myocardial infarction (MI) during nighttime hours. A study involving 92 patients found that 32% of those with OSA experienced MI between midnight and 6 am, compared to only 7% of non-OSA patients. The odds of having OSA were six times higher for patients who had an MI during these hours. This suggests that OSA may act as a trigger for nocturnal MI, and patients with nighttime MI should be evaluated for OSA.
Sleep Duration and Chest Pain
U-Shaped Relationship Between Sleep Duration and Chest Pain
The relationship between sleep duration and chest pain follows a U-shaped curve. Data from the National Health and Nutrition Examination Survey (NHANES) involving 13,274 subjects revealed that both insufficient sleep (<6.5 hours) and excessive sleep (≥6.5 hours) are associated with an increased risk of chest pain. Specifically, chest pain incidence decreased by 5% for each additional hour of sleep up to 6.5 hours, but increased with longer sleep durations. This highlights the importance of maintaining an optimal sleep duration to minimize the risk of chest pain.
Case Studies and Clinical Observations
Case of Nighttime Chest Discomfort and Sweats
A case study of a 55-year-old man reported progressive chest discomfort and night sweats over two months. His symptoms, including nonexertional chest tightness and palpitations at night, were not associated with dyspnea and resolved spontaneously. This case underscores the need for thorough evaluation of nighttime chest pain, even in the absence of other symptoms like fever or weight change.
Variant Angina and Nighttime Chest Pain
Variant angina, characterized by coronary arterial spasms, often occurs at rest and predominantly at night. This type of angina is associated with ST-segment elevation and can lead to severe chest pain during nocturnal hours . Patients with variant angina frequently report pain episodes in the early morning hours, suggesting a temporal pattern linked to the end of the nocturnal rest period.
Conclusion
Nighttime chest pain is a significant clinical concern, with a higher risk of acute coronary syndrome and myocardial infarction, particularly in patients with obstructive sleep apnea. Both insufficient and excessive sleep durations are linked to increased chest pain incidence, emphasizing the need for balanced sleep. Healthcare providers should be vigilant in assessing and managing nighttime chest discomfort, considering the potential for serious underlying conditions.
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