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

BACKGROUND: Coronary microvascular dysfunction (CMD) is a key mechanism in angina with nonobstructive coronary arteries (ANOCA). While psychological stress affects cardiovascular health, the link between specific psychological symptoms and CMD in ANOCA patients remains unclear. AIMS: This study aimed to investigate the association of anxiety, depression, and sleep disorder with CMD assessed by invasive coronary physiology in ANOCA patients. METHODS: A total of 102 ANOCA patients underwent coronary angiography and invasive coronary function testing with thermodilution-derived index of microcirculatory resistance (IMR) and coronary 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, the Patient Health Questionnaire-9, the Pittsburgh Sleep Quality Index scales, respectively. RESULTS: Among the enrolled 102 ANOCA patients, 50.0% exhibited anxiety symptoms, 30.4% showed depression symptoms, and 67.6% reported sleep disorders. Patients with abnormal IMR had significantly 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 analysis identified 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, sleep disorder showed a borderline association. Restricted cubic spline analyses showed dose-dependent CMD risk increases with worsening psychological symptoms, especially for IMR-defined CMD. CONCLUSIONS: Anxiety, depression, and sleep disorders are prevalent and dose-dependently associated with CMD in ANOCA, particularly elevated IMR.