Impact of objectively-measured sleep duration on cardiometabolic health: A systematic review of recent evidence (original) (raw)
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Sleep duration and cardiometabolic risk
Dozens of studies, spanning over 40 years and multiple continents, have reliably documented that self-reported short and long sleep durations are associated with increased mortality risk [1,2]. A recent meta-analysis [3] reports that the pooled relative risk (RR) of all-cause mortality was RR = 1.10 for short sleep duration and RR = 1.23 for long sleep duration. Specific cardiovascular mortality was reported to be RR = 1.06 for short sleep and RR = 1.38 for long sleep. Epidemiologic studies of habitual short sleep duration have found that sleep ≤6 h is associated with abnormalities in blood pressure, lipoproteins, glucose regulation, metabolic hormones, and obesity [4,5]. Less well-studied has been long sleep duration. However, many studies in the past two decades have found that individuals who report long sleep duration are at risk for a number of negative health outcomes as well [2,6]. Associations with long sleep duration have been reported for depression [7], cardiovascular disease [8], stroke [9], hypertension [10], diabetes [11], obesity [12], metabolic syndrome [13], dyslipidemia [14], and a number of cardiometabolic risk factors [2,6]. The study by Abe and colleagues in this issue represents one of the first to carefully assess atherosclerosis relative to sleep duration. This study, of >2000 residents of a Japanese community consisting of individuals 40–84 years ol examined intima-medial thickness (IMT), a marker of carotid artery arteriosclerosis. Although the sample was rather small for an epidemiologic study, the authors found that mean IMT increased significantly as self- reported sleep duration increased from 6 to 7 to 8 to≥9 h of sleep. Moreover, those with longer sleep durations were more likely to exhibit IMT ≥1.2 mm, which is a clinically accepted marker of atherosclerosis. The relationship of sleep duration with IMT was maintained even after controlling for a wide range of possible confounders, including sociodemographics, substance use, and other cardiometabolic measures. These data are consistent with other epidemiologic evidence linking long sleep with a higher risk of heart disease and stroke. Although other cardiovascular and metabolic markers were measured, including blood pressure, cholesterol, insulin, glucose, and others, the present study did not evaluate whether these also varied by sleep duration.
Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes
Sleep medicine, 2012
Objective: The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. Methods: A total of N = 30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI P 30 kg m À2 ) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency. Results: Results indicated that, when examined alone, sleep duration <5 h (versus 7 h) was related to BMI (B = 2.716, p < 0.01), obesity (B = 2.080, p < 0.000001), diabetes (B = 3.162, p < 0.000001), hypertension (B = 2.703, p < 0.000001), hypercholesterolaemia (B = 1.922, p < 0.00001), heart attack (B = 4.704, p < 0.000001) and stroke (B = 4.558, p < 0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B = 0.181, p < 0.01), obesity (B = 1.061, p < 0.000001) and hypercholesterolaemia (B = 1.025, p < 0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B = 1.039, p < 0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5 h (versus 7 h) and BMI (B = 1.266, p < 0.05), obesity (B = 1.389, p < 0.05), hypertension (B = 1.555, p < 0.01), heart attack (B = 2.513, p < 0.01) and stroke (B = 1.807, p < 0.05). It should be noted that relationships between sleep duration >9 h (versus 7 h) were seen for heart attack (B = 1.863, p < 0.001) and stroke (B = 1.816, p < 0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B = 1.031, p < 0.01) and hypertension (B = 1.027, p < 0.05). Conclusions: These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects.
Circulation, 2016
Sleep is increasingly recognized as an important lifestyle contributor to health. However, this has not always been the case, and an increasing number of Americans choose to curtail sleep in favor of other social, leisure, or work-related activities. This has resulted in a decline in average sleep duration over time. Sleep duration, mostly short sleep, and sleep disorders have emerged as being related to adverse cardiometabolic risk, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. Here, we review the evidence relating sleep duration and sleep disorders to cardiometabolic risk and call for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.
JMIR Research Protocols, 2021
Background Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors. Objective This SLUMBRx study aims to address 4 topics pertinent to the adiposity-sleep hypothesis: the r...
Role of Sleep and Sleep Disorders in Cardiometabolic Risk: a Review and Update
Current Sleep Medicine Reports, 2024
Purpose of Review Sleep plays a pivotal role in regulating numerous physiological functions, including cardiovascular activity, glucose regulation, lipid management, and hormone secretion. This review explores the impact of insufficient and irregular sleep, as well as specific sleep disorders, on cardiometabolic risk. We aim to illuminate the potential mechanisms underlying these associations. Recent Findings A substantial body of evidence links sleep duration (both short and long), sleep regularity, and disorders such as obstructive sleep apnea, insomnia, and restless leg syndrome with the development of obesity, hypertension, hyperlipidemia, inflammation, diabetes, cardiovascular complications, and related mortality. Summary Despite the significant volume of research highlighting the interplay between sleep disturbances and cardiometabolic disorders, our understanding of this intricate relationship remains somewhat incomplete. Future research is essential to deepen our understanding and identify therapeutic strategies and interventions that can mitigate the detrimental effects of sleep disorders on cardiometabolic health.
Short Sleep Duration Increases Metabolic Impact in Healthy Adults: A Population-Based Cohort Study
Sleep, 2017
Objectives: The metabolic impact of inadequate sleep has not been determined in healthy individuals outside laboratories. This study aims to investigate the impact of sleep duration on five metabolic syndrome components in a healthy adult cohort. Methods: A total of 162 121 adults aged 20-80 years (men 47.4%) of the MJ Health Database, who were not obese and free from major diseases, were recruited and followed up from 1996 to 2014. Sleep duration and insomnia symptoms were assessed by a self-administered questionnaire. Incident cases of five metabolic syndrome components were identified by follow-up medical examinations. Cox proportional hazard ratios (HRs) were calculated for three sleep duration categories "< 6 hours/day (short)," "6-8 hours/day (regular)," and "> 8 hours/day (long)" with adjustment for potential confounding factors. Analyses were stratified by insomnia symptoms to assess whether insomnia symptoms modified the association between sleep duration and metabolic syndrome. Results: Compared to regular sleep duration, short sleep significantly (p < .001) increased the risk for central obesity by 12% (adjusted HR 1.12 [1.07-1.17]), for elevated fasting glucose by 6% (adjusted HR 1.06 [1.03-1.09]), for high blood pressure by 8% (adjusted HR 1.08 [1.04-1.13]), for low high-density lipoprotein-cholesterol by 7% (adjusted HR 1.07 [1.03-1.11]), for hypertriglyceridemia by 9% (adjusted HR 1.09 [1.05-1.13]), and for metabolic syndrome by 9% (adjusted HR 1.09 [1.05-1.13]). Long sleep decreased the risk of hypertriglyceridemia (adjusted HR 0.89 [0.84-0.94]) and metabolic syndrome (adjusted HR 0.93 [0.88-0.99]). Insomnia symptoms did not modify the effects of sleep duration. Conclusions: Sleep duration may be a significant determinant of metabolic health.
Journal of Sleep Research, 2021
Sleep problems and short sleep duration have been linked to adverse health effects, such as cardiovascular disease and diabetes, but the mechanisms are not fully understood. Finding biomarkers could explain mechanistic pathways and help in understanding relationships between sleep and cardiometabolic health. The aim was to assess if sleep duration and sleep quality affect the cardiometabolic‐related protein profile. In total, 242 proteins related to cardiometabolic health were measured in 2,430 plasma samples (male:female ratio 1:1, aged 45–75 years) from the population‐based EpiHealth cohort, using a proximity extension assay. The association of self‐reported sleep duration and sleep quality with each of the 242 proteins (primary outcome) was assessed with linear regression modelling, adjusting for confounders, and corrected for multiple testing using the false discovery rate (5%). Potential effect modification of age and sex was also tested using an interaction term. We identified...
Sleep and Cardio-Metabolic Disease
Current Cardiology Reports, 2017
Purpose of Review This review summarises and discusses the epidemiological evidence suggesting a causal relationship between sleep duration and cardio-metabolic risk and outcomes in population. Recent Findings Sleep duration is affected by a variety of cultural, social, psychological, behavioural, pathophysiological and environmental influences. Changes in modern society-like longer working hours, more shift-work, 24/7 availability of commodities and 24-h global connectivity-have been associated with a gradual reduction in sleep duration and sleeping patterns across westernised populations. We review the evidence of an association between sleep disturbances and the development of cardio-metabolic risk and disease and discuss the implications for causality of these associations. Summary Prolonged curtailment of sleep duration is a risk factor for the development of obesity, diabetes, hypertension, heart disease and stroke and may contribute, in the long-term, to premature death.
Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes
Sleep Medicine, 2015
Objective: To examine the association between sleep duration and cardiometabolic risk factors among individuals with recently diagnosed type 2 diabetes (n = 391). Methods: Sleep duration was derived using a combination of questionnaire and objective heart rate and movement sensing in the UK ADDITION-Plus study (2002)(2003)(2004)(2005)(2006)(2007). Adjusted means were estimated for individual cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) by five categories of sleep duration. Results: We observed a J-shaped association between sleep duration and CCMR -individuals sleeping 7 to <8 h had a significantly better CCMR profile than those sleeping ≥9 h. Independent of physical activity and sedentary time, individuals sleeping 7 to <8 h had lower triacylglycerol (0.62 mmol/l (0.29, 1.06)) and higher high-density lipoprotein (HDL)-cholesterol levels (0.23 mmol/l (0.16, 0.30)) compared with those sleeping ≥9 h, and a lower waist circumference (7.87 cm (6.06, 9.68)) and body mass index (BMI) (3.47 kg/m 2 (2.69, 4.25)) than those sleeping <6 h. Although sleeping 7 to <8 h was associated with lower levels of systolic and diastolic blood pressure, HbA1c, total cholesterol, and low-density lipoprotein (LDL)cholesterol, these associations were not statistically significant. Conclusions: Sleep duration has a J-shaped association with CCMR in individuals with diabetes, independent of potential confounding. Health promotion interventions might highlight the importance of adequate sleep in this high-risk population. Please cite this article in press as: Andrew J.M. Cooper, et al., Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes, Sleep Medicine (2014), Values are expressed as means (SD) unless stated otherwise. p values are from p trend, Kruskal-Wallis and chi-squared tests, as appropriate. Abbreviations: IQR = interquartile range. PAEE = physical activity energy expenditure. ARTICLE IN PRESS Please cite this article in press as: Andrew J.M. Cooper, et al., Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes, Sleep Medicine (2014), Please cite this article in press as: Andrew J.M. Cooper, et al., Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes, Sleep Medicine (2014), Please cite this article in press as: Andrew J.M. Cooper, et al., Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes, Sleep Medicine (2014),