Sleep disruption and deprivation may lead to an increase in cardiovascular risk, an observational study affirmed.
When compared with people who slept 7 to 8 hours each night, those who slept less than 6 hours each night were 27% more likely to have artery plaque buildup outside of the coronaries (P=0.008), reported José Ordovás, PhD, of Tufts University in Boston, and colleagues in the Journal of the American College of Cardiology.
Poor quality sleep was associated with 34% higher likelihood of subclinical atherosclerosis, their Progression of Early Subclinical Atherosclerosis (PESA) study showed.
The 10- and 30-year Framingham risk scores showed significantly higher cardiovascular risk in those getting less than 6 hours of sleep as well as in those in the three higher quintiles of sleep fragmentation.
Healthy sleep patterns of 7 to 8 hours a night may be protective, although the study couldn’t determine causality, the researchers noted. “Thus, recommending a good sleep hygiene should be part of the lifestyle modifications provided in our daily clinical practice,” the study authors recommended.
Prior observational research has highlighted the robust relationship of both long and short habitual sleep periods with stroke, coronary heart disease, death, diabetes mellitus, hypertension, and obesity. However, those findings are limited because they rely on self-reported sleep information, which is often prone to known biases and measurement errors, noted Daniel Gottlieb, MD, MPH, of VA Boston Healthcare System, and Deepak Bhatt, MD, MPH, of Harvard Medical School in Boston, in an accompanying editorial.
Another limitation is that prior investigations included patients with established cardiovascular disease, hypertension, or diabetes, the editorialists pointed out. “Because these conditions and the medications used to treat them may affect sleep duration, causal interpretation of the data is often problematic,” they wrote.
In Ordovás’ study, the relationship between noncoronary atherosclerosis and self-reported sleep differed from that seen on actigraphy. Men who reported sleeping 6 to 7 hours were actually the only group to show significantly greater risk of noncoronary atherosclerosis.
The study involved actigraphic recordings for sleep fragmentation and duration assessment collected on 3,974 employees (mean age 45.8 years and 62.6% men) of the Bank Santander Headquarters based in Madrid over 7 days. The cohort had a low prevalence of diabetes mellitus and high blood pressure and did not have known cardiovascular disease. Individuals with obstructive sleep apnea were excluded from the study.
To quantify coronary calcification and noncoronary atherosclerosis, cardiac CT and femoral and carotid 3-dimensional vascular ultrasound were done.
Long sleep duration of more than 8 hours was uncommon (4%), and 30.7% fell into the reference group of 7 to 8 hours, but most had short sleep of 6 to 7 hours, or very short sleep duration of less than 6 hours (together 65.3%).
The results also showed sleeping more than 8 hours was linked with a greater atherosclerotic burden with a much stronger association among women (OR 1.95, 95% CI 1.20-3.19) than in men (OR 1.07, 95% CI 0.64-1.80).
Notably, caffeine and alcohol intake were greater in participants with disrupted and short sleep. Coronary artery calcium score and inflammation biomarkers were not effected by sleep quality or length.
Looking ahead, “prospective studies are needed to assess the impact of specific interventions that improve sleep hygiene on clinical ischemic events,” the researchers wrote.
The PESA study is funded by CNIC and Banco Santander, the Institute of Health Carlos III, the European Regional Development Fund, the Ministry of Economy, Industry, and Competitiveness, the Pro CNIC Foundation, and the Severo Ochoa Center of Excellence.
Ordovás did not report any disclosures.
Gottlieb disclosed relationships with the American Academy of Sleep Medicine, Advance Medical and T. Leland Seeger and Associates, and the ResMed Corporation.
Bhatt disclosed relationships with Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences, the Boston VA Research Institute, the Society of Cardiovascular Patient Care, TobeSoft, the American Heart Association Quality Oversight, the Baim Institute for Clinical Research, the Cleveland Clinic, Duke Clinical Research Institute, the Mayo Clinic, Mount Sinai School of Medicine, the Population Health Research Institute, the American College of Cardiology, the Baim Institute for Clinical Research, Belvoir Publications, the Duke Clinical Research Institute, HMP Global, the Journal of the American College of Cardiology, the Population Health Research Institute, Slack Publications, the Society of Cardiovascular Patient Care, WebMD, Clinical Cardiology, the NCDR-ACTION Registry Steering Committee, the VA CART Research and Publications Committee, Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, The Medicines Company, Elsevier, Biotronik, Boston Scientific, St. Jude Medical, Svelte, FlowCo, Merck, Novo Nordisk, and PLx.