Self-Reported Sleep Quality and Circadian Rest-Activity Patterns in Patients With Cardiac Implantable Electronic Devices.

Background: Poor sleep quality is a critical concern for patients with cardiac implantable electronic devices (CIEDs). The aim of this study was to investigate the relationship between sleep quality and circadian rest-activity patterns in patients with CIEDs in Japan. Methods and Results: Fifty-four patients with CIEDs were recruited. Sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index, with scores ≤5 (n=19 participants) and ≥6 (n=35 participants) indicating good and poor sleep quality, respectively. Participants were instructed to wear 'Life Microscope' wristbands for 3 days at home to track their activity levels. Hourly mean values were calculated for the metabolic equivalents from the obtained activity levels, and subsequently evaluated using cosine periodic regression analysis. Parameters of circadian rest-activity patterns analyzed included mesor (mean activity), amplitude (range of activity), and acrophase time (time of peak activity). Sleep metrics, including total sleep time, sleep efficiency, and number of awakenings, were also evaluated. The Mann-Whitney U test showed that the poor sleep quality group exhibited significantly lower mesor, smaller amplitude, and later acrophase time. No other significant between-group differences were found. Furthermore, logistic regression analysis showed that acrophase time remained independently associated with self-reported sleep quality. Conclusions: Focusing on improving daily activity levels and adjusting acrophase time may be essential to improve sleep quality in patients with CIEDs.