Inadequate sleep may be early sign of heart disease

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Adults who get too much or too little sleep may have the beginnings of “hardening” of the arteries, which can be an early sign of heart disease, Reuters Health reports that a new study has found. “Many people, up to one third or one fourth of the general population, suffer from inadequate sleep – either insufficient duration of sleep or poor quality of sleep,” said co-lead author Dr Chan-Won Kim of Kangbuk Samsung Hospital of Sungkyunkwan University School of Medicine in Seoul, South Korea.

Several studies have linked inadequate sleep with an increased risk of heart attack and stroke, but other conditions like depression or obesity could influence this association, Kim is quoted in the report as saying. “In contrast, we studied if sleep of inadequate duration or quality would be linked to early markers of heart disease in asymptomatic healthy adults free of heart disease,” Kim said.

For the study, more than 47,000 men and women, age 42 on average, completed a sleep questionnaire and had tests to detect lesions of calcium and plaque in the artery leading to the heart, an early sign of disease, and arterial stiffness in the leg, a sign of vascular aging. According to their questionnaires, the participants’ average sleep duration was 6.4 hours per night, and about 84% said their sleep quality was “good.” The researchers considered those who got five hours or less per night to be “short” sleepers, and those who got nine or more hours to be “long” sleepers.

Short sleepers had 50% more calcium in their coronary arteries than those who slept for seven hours per night, according to the results. Long sleepers had 70% more calcium than those who slept seven hours. “The calcium score obtained by computerised tomography scan is a very good measure of calcium build-up in the coronary arteries reflecting coronary atherosclerosis,” Kim said. “The higher the coronary calcium score, the greater the risk of having a heart attack in the future.” Those who reported poor sleep quality also tended to have more coronary calcium and more arterial stiffness.

In a 2013 study, people who tended to get less than six hours of sleep nightly were more likely to have high blood pressure, high cholesterol, diabetes and to be obese

“Adults with poor sleep quality have stiffer arteries than those who sleep seven hours a day or had good sleep quality,” co-lead author Dr Yoosoo Chang of the Centre for Cohort Studies at Kangbuk Samsun Hospital said. “Overall, we saw the lowest levels of vascular disease in adults sleeping seven hours a day and reporting good sleep quality.”

Short sleepers were more likely than others to be older, have depression, type 2 diabetes or to be smokers.

“The associations of too short or too long sleep duration and of poor sleep quality with early indicators of heart disease, such as coronary calcium and arterial stiffness, provides strong support to the increasing body of evidence that links inadequate sleep with an increased risk of heart attacks,” Kim said. The study does not prove that too little sleep is a cause of early arterial disease, rather than a sign of it or of other medical problems.

Self-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues.
Adult respondents of the 2007–2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N = 5649). Self-reported sleep duration was categorized as very short ( Results
In adjusted analyses, very short sleep was associated with self-reported hypertension (odds ratio [OR], 2.02, [95% confidence interval {CI},1.45–2.81]; P < 0.0001), self-reported hyperlipidemia (OR, 1.96 [95% CI, 1.43–2.69]; P < 0.0001), objective hyperlipidemia (OR, 1.41 [95% CI, 1.04–1.91]; P = 0.03), self-reported DM (OR, 1.76 [95% CI, 1.13–2.74]; P = 0.01), and objective obesity (OR, 1.53 [95% CI, 1.03–1.43]; P = 0.005). Regarding short sleep (5–6 h), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR, 1.22 [95% CI, 1.02–1.45]; P = 0.03) self-reported obesity (OR, 1.21 [95% CI, 1.03–1.43]; P = 0.02), and objective obesity (OR, 1.17 [95% CI, 1.00–1.38]; P < 0.05). Regarding long sleep (⩾9 h), no elevated risk was found for any outcomes. Interactions with race/ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among blacks and the relationship between short sleep and hypertension is strongest among non-Hispanic whites, blacks, and non-Mexican Hispanics/Latinos.
Short sleep duration is associated with self-reported and objectively determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.

Objective—Short and long sleep duration are associated with increased risk of clinical cardiovascular events, but the association between sleep duration and subclinical cardiovascular disease is not well established. We examined the association between sleep duration and sleep quality with coronary artery calcification (CAC) and with brachial–ankle pulse wave velocity (PWV) in a large sample of young and middle-aged asymptomatic adults.
Approach and Results—We conducted a cross-sectional study of adult men and women who underwent a health checkup examination, including assessment of sleep duration and quality and coupled with either CAC (n=29 203) or brachial–ankle PWV (n=18 106). The multivariate-adjusted CAC score ratios (95% confidence interval) comparing sleep durations of ≤5, 6, 8, and ≥9 hours with 7 hours of sleep were 1.50 (1.17–1.93), 1.34 (1.10–1.63), 1.37 (0.99–1.89), and 1.72 (0.90–3.28), respectively (P for quadratic trend=0.002). The corresponding average differences in brachial–ankle PWV were 6.7 (0.75–12.6), 2.9 (−1.7 to 7.4), 10.5 (4.5–16.5), and 9.6 (−0.7 to 19.8) cm/s, respectively (P for quadratic trend=0.019). Poor subjective sleep quality was associated with CAC in women but not in men, whereas the association between poor subjective sleep quality and brachial–ankle PWV was stronger in men than in women.
Conclusions—In this large study of apparently healthy men and women, extreme sleep duration and poor subjective sleep quality were associated with increased prevalence of CAC and higher PWV. Our results underscore the importance of an adequate quantity and quality of sleep to maintain cardiovascular health.

Full Reuters Health report
Sleep Medicine abstract
Arteriosclerosis, Thrombosis and Vascular Biology abstract

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