β-Blockers, anxiety, and sleep: an analysis of interactions in early sleep disorders following percutaneous complete revascularization

To investigate the factors influencing sleep quality in the early postoperative period following complete revascularization, focusing on the interaction between anxiety levels and β-blocker use, and to examine whether this interaction is moderated by variables such as insulin resistance and the severity of coronary heart disease (CHD). A total of 186 patients with CHD who had undergone interventional therapy were assessed using various scales during an outpatient follow-up visit three months post-procedure. Univariate and binary logistic regression analyses were conducted to identify factors influencing sleep quality. Subsequently, the PROCESS macro was used to perform interaction and subgroup analyses. Anxiety (OR = 0.86, P = 0.023) and depression (OR = 0.81, P = 0.009) were independent negative predictors of sleep quality. The interaction between β-blockers (predominantly metoprolol) and anxiety on sleep was significant (OR = 1.39, P = 0.045), with notable heterogeneity across subgroups. In patients with preserved metabolic function (HOMA-IR < 2.5, OR = 0.61, P = 0.017) or mild coronary lesions (Gensini score < 33, OR = 0.57, P = 0.027), β-blockers significantly amplified the negative impact of anxiety on sleep. Conversely, this interaction was not observed in patients with insulin resistance, severe coronary lesions, or depression. β-Blockers and anxiety exhibit a significant interaction affecting early post-PCI sleep quality, with this effect predominantly observed in metabolically healthier patients with mild coronary lesions. This suggests that intact physiological function may paradoxically increase susceptibility to drug–psychological interactions. Clinicians should monitor sleep quality when prescribing lipophilic β-blockers to these patients. These exploratory findings require validation in prospective studies using objective sleep assessments.