The Association of Nocturnal Angina Pectoris with Dreaming

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Abstract
De-spite the importance of physical rest in reducing the frequency and duration of episodes of angina pectoris, certain patients with coronary artery disease are awakened from sleep by chest pain. Four patients, with symptoms of both exertional and nocturnal angina, have been studied throughout several evenings of sleep. Previously, all had documented EKG changes with exertional pain. Continuous EEG, EKG, respiratory rate and eye movements were recorded. Rapid Eye Movement (REM) patterns, seen in the second of the 5 EEG stages of sleep, correlate well with the dreaming state. In the patients studied, there was a total of 39 episodes of nocturnal chest pain with EKG changes of angina; 32 episodes occurred in association with REM activity. In 2 of the 4 patients, there was a significant correlation (p < .05) between REM periods and nocturnal chest pain with EKG changes. Onset of dreaming periods, as indicated by REM activity, regularly preceded the patients in whom this association of events occurred. The mechanism by which the arousal state of dreaming initiates anginal episodes is presently unclear.

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