Myocardial infarction (MI) is a series of events that includes myocardial ischemia and necrosis events, resulting from insufficient myocardial blood supply due to vascular blockage [1]. Subsequently, survivors of an MI often experience multiple post-infarction symptoms. Approximately 55% of patients display varying degrees of sleep disorders four months after MI, which can impede cardiac recovery [2]. Notably, clinical observations have revealed that insomnia, including difficulty staying asleep, is prevalent in individuals post-MI [3]. Furthermore, MI patients with short sleep durations have a higher incidence of major adverse cardiovascular events (MACEs) compared to those without sleep disorders [4, 5].

Sleep plays an important role in maintaining overall health and daily functioning [5]. Approximately 22% of the global population experiences insomnia symptoms [6], which typically include difficulty falling asleep, trouble sustaining sleep, which means waking up frequently or prematurely during the night, and waking up too early in the morning [7, 8, 9]. The prevalence of insomnia is increasing [10]. Insomnia can lead to the development of MI, and MI can lead to the development of insomnia [11, 12, 13]. Prolonged and reduced sleep durations are both linked to higher mortality rates, and the presence of insomnia symptoms further exacerbates deaths related to cardiovascular disease [14, 15]. These conditions significantly reduce the quality of life and impose a substantial disease burden.

Current research indicates that insomnia is associated with endocrine, metabolic, cortical function, and neurological disorders [16], as well as risk factors such as lack of exercise and an irregular diet [17]. Insomnia is also correlated with body mass index (BMI), hypertension, anxiety and depression [18, 19, 20].

Recognizing patients predisposed to post-infarction insomnia early and providing timely interventions is crucial. However, the current literature on post-infarction insomnia, especially concerning short sleep duration after MI, is limited. Consequently, there is a lack of existing guidelines or risk prediction models to assist physicians. Developing a numerically-scored risk identification system for post-MI short sleep duration would significantly improve patients’ life quality. This study, utilizing the National Health and Nutrition Examination Survey (NHANES) database, aims to establish a risk prediction method for post-MI short sleep duration by examining relevant factors.

To date, a risk prediction method targeting short sleep duration following MI has not been previously developed. This study pioneers this field by utilizing data from 1417 MI survivors sourced from the NHANES database.

We found that patients with post-MI depression were more likely to have a short sleep duration. Similarly, age exhibited an inverse correlation with short sleep duration. Moreover, our analysis revealed a notable observation: MI survivors who engage in regular weekly exercise tend to have a decreased risk of short sleep duration. Interestingly, while many studies have emphasized the role of health conditions like hypertension and diabetes in determining sleep patterns, our dataset did not identify any significant variance in sleep duration based on these conditions. Another intriguing observation is the negative association of PIR with short sleep duration, post-MI. This suggests a potential socioeconomic dimension to the issue, indicating that individuals with lower income brackets might be at a greater risk [24]. Interestingly, there were statistically significant differences in short sleep duration after myocardial infarction among races. Specifically, compared to Mexican Americans, Non-Hispanic Black individuals showed the highest risk. While we categorized race into two broader categories for ease of interpretation in the nomogram, future research might benefit from a more nuanced approach, assigning unique scores to each racial group to enhance prediction accuracy. Despite gender being a significant factor in many health outcomes, our data did not delineate a notable difference between genders in terms of post-MI sleep duration. This finding is contrary to earlier research, which identified gender-specific causes for MI [25].

To enhance the precision of our variable selection, we incorporated the LASSO binary regression and cross-validation techniques. The alignment between this approach and binary logistic regression fortified the credibility of our predictive model. The area under the curve (AUC) in the training group was 0.636, and in the testing group was 0.657, indicating the good stability of the model. The calibration curve further affirmed the model’s accuracy in predicting short sleep duration after myocardial infarction. Given that most of the predictor variables included in the model are objective demographic characteristics, along with the PIR having geographic distribution characteristics, we assumed that the predicted outcome will not be influenced by the subjective feelings of the physician or patients. The Patient Health Questionnare-9 (PHQ-9), a primary depression questionnaire, is widely recognized for its validity [26]. Due to database limitations, we did not include patient biochemical indicators, inflammatory markers, and other data. However, our predictive model still demonstrated good predictive performance, which can help doctors in identifying whether patients are likely to experience short sleep duration after myocardial infarction in advance, ultimately improving their quality of life. Furthermore, it is important to note that the pathogenesis of short sleep duration after myocardial infarction is limited to the reasons mentioned above and remains a subject for further study. The sensitivity of patients’ responses to stress after MI varies, as does the timing of the onset of short sleep duration [13]. Therefore, the assessment of short sleep duration risk in post-MI patients should be dynamic. A nomogram score of 0 does not mean that a patient will not experience short sleep duration, and this possibility should not be ignored.

Studies have shown that patients who sleep less than six hours are at increased risk of developing hypertension, experiencing acute myocardial infarction, heart failure, and higher morbidity and mortality rates [27]. In fact, sleeping for less than six hours at night has been linked to an increased risk of cardiovascular diseases in multiple studies [28, 29, 30]. In this study, sleep of less than 6 hours was specifically defined as short sleep duration [22, 31]. Interestingly, in European countries, the initial goal of treatment for patients with short sleep duration is to achieve 6.5 hours [32]. However, it has also been noted that short sleep duration, such as $\le$5 hours, has also been strongly associated with myocardial infarction [33].

However, it is imperative to acknowledge the limitations of our study. The symptoms of short sleep duration include difficulty falling asleep, frequent waking up during the night, and premature awakening. Early awakening indicates a lack of sleep time. In this study, we focused on the situation of insufficient sleep time due to the limitations of the sample data, preventing us from obtaining more detailed information about the sleep status of the subjects. In the subsequent clinical study, assessment tools like the Jenkins Sleep Scale (JSS)-4 [34], the Pittsburgh Sleep Quality Index (PSQI) [35] and the Bergen Short sleep duration Scale (BIS) [36] can be used to comprehensively evaluate the sleep status of individual patients. Furthermore, it is important to acknowledge that there are numerous causes of short sleep duration, and insufficient sleep time may be a result of either short sleep or reduced sleep duration. Unfortunately, we were unable to obtain detailed reasons for each participant’s insufficient sleep time from the questionnaire. Based on these limitations, future research should aim for greater refinement to investigate the underlying causes of short sleep duration after myocardial infarction and to develop strategies for its prevention and intervention.

Highlighting the importance of disease prevention is equally, if not more critical than focusing solely on treatment. Patients suffering from diseases such as hypertension, coronary heart disease, and myocardial infarction not only endure physical pain but also experience a serious psychological burden as a result of their illness. It is expected to find appropriate drugs for preventing or treating short sleep duration after an MI to achieve a dual benefit. This is evident in the connection between hypoglycemic drugs and cardiovascular diseases. The therapeutic role of anti-diabetic medications like metformin is manifested through the reduction of cardiac pump deterioration and heart failure events [37]. The effect is achieved via their systemic and local anti-inflammatory properties [38], as well as in patients with non-obstructive coronary stenosis and endothelial dysfunction [39]. Notably, sodium–glucose transporter 2 inhibitors (SGLT2i) have recently demonstrated beneficial effects on endothelial dysfunction [40]. They play a role in stabilizing atherosclerotic coronary plaques and reducing adverse cardiac events following myocardial infarction [41, 42]. Additionally, for post-myocardial infarction patients experiencing short sleep duration, detecting and intervening in patients with a mental health condition in a timely manner during the diagnosis and treatment process are crucial. Whenever possible, a single drug treatment can help reduce the medication burden on patients, ultimately improving clinical outcomes in patients with acute myocardial infarction, thus ensuring the best possible treatment for the patients.

We innovatively proposed a model to predict the risk of short sleep duration after MI, based on the demographic information of patients and the characteristics of self-reporting. Our nomogram can predict the probability of myocardial infarction survivors with short sleep duration, helping clinical doctors prevent and intervene in the occurrence of short sleep duration after MI.

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

GQ designed the research study. JX performed the research and analyzed the data. JX and GQ revised the manuscript and confirmed the final published version. Both authors contributed to editorial changes in the manuscript. Both authors read and approved the final manuscript. Both authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

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This article was supported by the Shanxi Patent Transformation Project (No. 202201020).

The authors declare no conflict of interest.