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HomeCardiologyNot enough night-time sleep linked to clogged arteries – Swedish study

Not enough night-time sleep linked to clogged arteries – Swedish study

Sleeping less than five hours a night has been linked to a 74% jump in risk of developing peripheral artery disease (PAD), compared with seven to eight hours of sleep, found scientists at the Karolinska Institute in a recent study.

More than 200m people worldwide have PAD, which causes the arteries in the legs to clog, restricting blood flow and increasing the risk of stroke and heart attack.

“Our study suggests that sleeping for seven to eight hours a night is a good habit for lowering the risk of PAD,” said study author Dr Shuai Yuan.

“Insufficient night-time sleep and daytime napping have previously been associated with a raised risk of coronary artery disease which, like PAD, is caused by clogged arteries.

“In addition, sleeping problems are among the top ranked complaints in PAD patients.  There is limited data on the impact of sleep habits on PAD and vice versa, and our study aimed to fill that gap.”

The team studied 650 000 participants in a two-part analysis. Researchers first carried out an observational study, which explored the link between sleep duration and daytime napping with the risk of peripheral artery disease.

They then used genetic data of 608 610 adults to do naturally randomised controlled trials, called Mendelian randomisation.

“Observational analyses are limited by reverse causality – meaning that if an association between sleep habits and PAD is found, we cannot be certain if sleep habits caused PAD or having PAD caused the sleep habits,” said Yuan. “Mendelian randomisation is a robust method for evaluating causality and provides more certainty about the results.”

The observational analysis of just under 53 500 adults shows that those who slept less than five hours a night were nearly double at risk of PAD.

The Mendelian randomisation method supported this finding. Results showed that while short sleep increased the risk of PAD, the condition was linked to an increased likelihood of short sleep.

Does excess sleep impact PAD risk?

Sleeping too much can also be risky. The adults who slept for eight hours or more were linked to a 24% higher risk of developing peripheral artery disease. However, the Mendelian randomisation method shows that there was no causal relationship found between long sleep and PAD.

This was similar to the results of those who took naps. Daytime nappers had a 32% higher risk of PAD but there were no causal links found.

“More studies are needed on the relationships between lengthy night-time sleep, daytime napping and PAD,” said Yuan. “Although we found associations in the observational studies, we could not confirm causality. More research is needed on how to interrupt the bidirectional link between short sleep and PAD.

“Lifestyle changes that help people get more sleep, like being physically active, may lower the risk of developing PAD.  For patients with PAD, optimising pain management could enable them to have a good night’s  sleep.”

Study details

Sleep duration, daytime napping, and risk of peripheral artery disease: multinational cohort and Mendelian randomisation studies 

Shuai Yuan, Michael Levin, Olga Titova, Jie Chen, Yuhao Sun, Veterans Affairs Million Veteran Program, Agneta Åkesson, Xue Li, Scott Damrauer, Susanna Larsson.

Published in the European Heart Journal in March 2023


Sleep duration has been associated with cardiovascular disease, however the effect of sleep on peripheral artery disease (PAD) specifically remains unestablished. We conducted observational and Mendelian randomisation (MR) analyses to assess the associations of sleep duration and daytime napping with PAD risk.

Methods and results
Sleep traits were assessed for associations with incident PAD using cohort analysis among 53 416 Swedish adults. Replicated was sought in a case-control study of 28 123 PAD cases and 128 459 controls from the veterans affairs Million Veteran Program (MVP) and a cohort study of 452 028 individuals from the UK Biobank study (UKB). Two-sample Mendelian randomisation (MR) was used for casual inference-based analyses of sleep-related traits and PAD (31 307 PAD cases 211 753 controls). Observational analyses demonstrated a U-shaped association between sleep duration and PAD risk. In Swedish adults, incident PAD risk was higher in those with short sleep [<5 h; hazard ratio (HR) 1.74; 95% confidence interval (CI) 1.31–2.31] or long sleep (≥8 h; HR 1.24; 95% CI 1.08–1.43), compared to individuals with a sleep duration of 7 to <8 h/night. This finding was supported by the analyses in MVP and UKB. Observational analysis also revealed positive associations between daytime napping (HR 1.32, 95% CI 1.18–1.49) with PAD. MR analysis supported an inverse association between sleep duration [odds ratio (OR) per hour increase: 0.79, 95% CI, 0.55, 0.89] and PAD and an association between short sleep and increased PAD (OR 1.20, 95% CI, 1.04–1.38).

Short sleep duration was associated with an increased risk of PAD.


European Heart Journal article – Sleep duration, daytime napping, and risk of peripheral artery disease: multinational cohort and Mendelian randomization studies (Creative Commons Licence)


Study Finds article – Not getting enough sleep can nearly double risk of clogged leg arteries (Open access)


See more from MedicalBrief archives:


Sleep duration’s effect on elevated heart risk — ACC:2021


Napping cuts hypertension as much as does salt and alcohol reduction


Healthy sleep habits linked to 42% lower risk of heart failure —UK Biobank data


Under 6 hours sleep a night associated with 30% higher dementia risk


Statins cut peripheral artery disease mortality, even when started long after diagnosis


Increased fruit and veggies uptake reduces PAD risk




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