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MUNICH – Getting less than 6 hours of sleep nightly on a regular basis or waking up multiple times was independently associated with increased risk of subclinical atherosclerosis in the Spanish PESA study, Fernando Dominguez, MD, reported at the annual congress of the European Society of Cardiology.
Moreover, a graded response was evident in PESA (Progression of Early Subclinical Atherosclerosis): The more times an individual typically awoke per night, the greater the number of atherosclerotic carotid or femoral artery territories documented on three-dimensional vascular ultrasound, added Dr. Dominguez of the Spanish National Center for Cardiovascular Research in Madrid.
the cardiologist said.
The cross-sectional PESA study, whose principal investigator was Valentin Fuster, MD, PhD, included 3,974 middle-aged Madrid bank employees free of known heart disease or history of stroke who wore a waistband activity monitor for a week to record sleep quantity and quality. They also underwent three-dimensional vascular ultrasound and measurement of coronary artery calcium.
PESA was one of several large studies presented at the meeting that focused on deviations from normal sleep as a marker for increased risk of cardiovascular disease and/or mortality. Of note, however, PESA was the only one to use activity monitoring technology to track sleep.
“It was essential to use objectively measured sleep variables, because they showed huge disparity with patients’ self-reports on sleep questionnaires,” Dr. Dominguez explained.
Indeed, while 10.7% of PESA participants self-reported sleeping less than 6 hours per night on the Sleep Habits Questionnaire, actigraphy showed the true rate was 27.1%.
Based on actigraphic findings, subjects were divided into tertiles based upon average hours of sleep per night, ranging from less than 6 to more than 8. They were also grouped in quintiles based upon their extent of fragmented sleep.
Subjects with short sleep were significantly older and more likely to have high blood pressure, a higher body mass index, and metabolic syndrome than those who averaged 7-8 hours of sleep. Individuals in the top quintile for sleep awakening were older and had higher prevalences of smoking and hypertension than those in the lowest quintile.
In multivariate analyses adjusted for these differences as well as for physical activity, depression, obstructive sleep apnea, daily calorie consumption, alcohol intake, and other potential confounders, subjects who slept less than 6 hours per night had a 27% greater volume of noncoronary plaque than those who slept 7-8 hours. They also had 21% more vascular territories laden with subclinical atherosclerosis. The risk of subclinical noncoronary atherosclerosis was greater among women who averaged less than 6 hours of sleep per night, representing a 48% relative risk increase in plaque volume, versus 21% in men.
At the other extreme, women who slept more than 8 hours per night had an 83% increased plaque volume, while men who slept that much had no increase in risk, compared with men who slept for 7-8 hours.
Subjects in the top quintile for sleep fragmentation had 34% more vascular territories affected by atherosclerosis than those in the lowest quintile. Their noncoronary plaque burden was 23% greater as well.
An 11-study meta-analysis
Epameinondas Fountas, MD, of the Onassis Cardiac Surgery Center in Athens, presented a meta-analysis of 11 prospective studies of the relationship between daily sleep duration and cardiovascular disease morbidity and mortality published within the past 5 years, reflecting burgeoning interest in this hot-button topic. Collectively, the meta-analysis totaled 1,000,541 adults without baseline cardiovascular disease who were followed for an average of 9.3 years.
In an analysis adjusted for numerous known cardiovascular risk factors, the Greek investigators found that short sleep duration as defined by a self-reported average of less than 6 hours per night was independently associated with a statistically significant and clinically meaningful 11% increase in the risk of diagnosis of fatal or nonfatal cardiovascular disease, compared with individuals who averaged 6-8 hours nightly. Moreover, those who averaged more than 8 hours of sleep per night were also at risk: they averaged a 32% increased risk in fatal or nonfatal cardiovascular events compared to normal 6- to 8-hour sleepers. Thus, 6-8 hours of sleep per night appears to be the sweet spot in terms of cardioprotection.
“Our message to patients is simple: Sleep well, not too long, nor too short, and be active,” Dr. Fountas said.
Numerous investigators have highlighted the pathophysiologic changes related to sleep deprivation that likely boost cardiovascular risk. These include activation of the sympathetic nervous system, increased inflammation, and disrupted glucose metabolism, he noted.
Swedes weigh in
Moa Bengtsson, a combined medical/PhD student at the University of Gothenburg (Sweden), presented a prospective study of 798 men who were 50 years old in 1993, when they underwent a physical examination and completed extensive lifestyle questionnaires that included average self-reported sleep duration. Among the 759 men still available for evaluation after 21 years, or nearly 15,000 person-years of followup, those who reported sleeping an average of 5 hours or less per night back at age 50 were 93% more likely to have experienced a major cardiovascular event by age 71 -- acute MI, stroke, coronary revascularization, heart failure hospitalization, or cardiovascular death -- compared with those who averaged 7-8 hours of shut eye.
The short sleepers had a higher prevalence of obesity, diabetes, hypertension, smoking, and physical inactivity than the men who slept 7-8 hours per night. However, these and other confounders were adjusted for in the multivariate analysis.
To place sleep abnormalities in context, Ms. Bengtssen observed that short sleep in the Gothenburg men was numerically a stronger independent risk factor for future cardiovascular events than obesity, which was associated with an 82% increase in risk, or even smoking, with a 70% increase in risk.
Men who averaged either 6 hours of sleep per night or more than 8 hours were not at increased cardiovascular risk over 21 years of followup, compared with those who slept 7-8 hours.
Like the other investigators, she noted that the studies presented at the meeting, despite their extensive adjustments for potential confounders, don’t prove a direct causal relationship between short sleep and increased cardiovascular risk. An informative next step in research, albeit a challenging one, would be to show whether improved long-term sleep habits favorably alter cardiovascular risk.
All three study investigators reported having no financial conflicts regarding their research, which was conducted free of commercial support.
MUNICH – Getting less than 6 hours of sleep nightly on a regular basis or waking up multiple times was independently associated with increased risk of subclinical atherosclerosis in the Spanish PESA study, Fernando Dominguez, MD, reported at the annual congress of the European Society of Cardiology.
Moreover, a graded response was evident in PESA (Progression of Early Subclinical Atherosclerosis): The more times an individual typically awoke per night, the greater the number of atherosclerotic carotid or femoral artery territories documented on three-dimensional vascular ultrasound, added Dr. Dominguez of the Spanish National Center for Cardiovascular Research in Madrid.
the cardiologist said.
The cross-sectional PESA study, whose principal investigator was Valentin Fuster, MD, PhD, included 3,974 middle-aged Madrid bank employees free of known heart disease or history of stroke who wore a waistband activity monitor for a week to record sleep quantity and quality. They also underwent three-dimensional vascular ultrasound and measurement of coronary artery calcium.
PESA was one of several large studies presented at the meeting that focused on deviations from normal sleep as a marker for increased risk of cardiovascular disease and/or mortality. Of note, however, PESA was the only one to use activity monitoring technology to track sleep.
“It was essential to use objectively measured sleep variables, because they showed huge disparity with patients’ self-reports on sleep questionnaires,” Dr. Dominguez explained.
Indeed, while 10.7% of PESA participants self-reported sleeping less than 6 hours per night on the Sleep Habits Questionnaire, actigraphy showed the true rate was 27.1%.
Based on actigraphic findings, subjects were divided into tertiles based upon average hours of sleep per night, ranging from less than 6 to more than 8. They were also grouped in quintiles based upon their extent of fragmented sleep.
Subjects with short sleep were significantly older and more likely to have high blood pressure, a higher body mass index, and metabolic syndrome than those who averaged 7-8 hours of sleep. Individuals in the top quintile for sleep awakening were older and had higher prevalences of smoking and hypertension than those in the lowest quintile.
In multivariate analyses adjusted for these differences as well as for physical activity, depression, obstructive sleep apnea, daily calorie consumption, alcohol intake, and other potential confounders, subjects who slept less than 6 hours per night had a 27% greater volume of noncoronary plaque than those who slept 7-8 hours. They also had 21% more vascular territories laden with subclinical atherosclerosis. The risk of subclinical noncoronary atherosclerosis was greater among women who averaged less than 6 hours of sleep per night, representing a 48% relative risk increase in plaque volume, versus 21% in men.
At the other extreme, women who slept more than 8 hours per night had an 83% increased plaque volume, while men who slept that much had no increase in risk, compared with men who slept for 7-8 hours.
Subjects in the top quintile for sleep fragmentation had 34% more vascular territories affected by atherosclerosis than those in the lowest quintile. Their noncoronary plaque burden was 23% greater as well.
An 11-study meta-analysis
Epameinondas Fountas, MD, of the Onassis Cardiac Surgery Center in Athens, presented a meta-analysis of 11 prospective studies of the relationship between daily sleep duration and cardiovascular disease morbidity and mortality published within the past 5 years, reflecting burgeoning interest in this hot-button topic. Collectively, the meta-analysis totaled 1,000,541 adults without baseline cardiovascular disease who were followed for an average of 9.3 years.
In an analysis adjusted for numerous known cardiovascular risk factors, the Greek investigators found that short sleep duration as defined by a self-reported average of less than 6 hours per night was independently associated with a statistically significant and clinically meaningful 11% increase in the risk of diagnosis of fatal or nonfatal cardiovascular disease, compared with individuals who averaged 6-8 hours nightly. Moreover, those who averaged more than 8 hours of sleep per night were also at risk: they averaged a 32% increased risk in fatal or nonfatal cardiovascular events compared to normal 6- to 8-hour sleepers. Thus, 6-8 hours of sleep per night appears to be the sweet spot in terms of cardioprotection.
“Our message to patients is simple: Sleep well, not too long, nor too short, and be active,” Dr. Fountas said.
Numerous investigators have highlighted the pathophysiologic changes related to sleep deprivation that likely boost cardiovascular risk. These include activation of the sympathetic nervous system, increased inflammation, and disrupted glucose metabolism, he noted.
Swedes weigh in
Moa Bengtsson, a combined medical/PhD student at the University of Gothenburg (Sweden), presented a prospective study of 798 men who were 50 years old in 1993, when they underwent a physical examination and completed extensive lifestyle questionnaires that included average self-reported sleep duration. Among the 759 men still available for evaluation after 21 years, or nearly 15,000 person-years of followup, those who reported sleeping an average of 5 hours or less per night back at age 50 were 93% more likely to have experienced a major cardiovascular event by age 71 -- acute MI, stroke, coronary revascularization, heart failure hospitalization, or cardiovascular death -- compared with those who averaged 7-8 hours of shut eye.
The short sleepers had a higher prevalence of obesity, diabetes, hypertension, smoking, and physical inactivity than the men who slept 7-8 hours per night. However, these and other confounders were adjusted for in the multivariate analysis.
To place sleep abnormalities in context, Ms. Bengtssen observed that short sleep in the Gothenburg men was numerically a stronger independent risk factor for future cardiovascular events than obesity, which was associated with an 82% increase in risk, or even smoking, with a 70% increase in risk.
Men who averaged either 6 hours of sleep per night or more than 8 hours were not at increased cardiovascular risk over 21 years of followup, compared with those who slept 7-8 hours.
Like the other investigators, she noted that the studies presented at the meeting, despite their extensive adjustments for potential confounders, don’t prove a direct causal relationship between short sleep and increased cardiovascular risk. An informative next step in research, albeit a challenging one, would be to show whether improved long-term sleep habits favorably alter cardiovascular risk.
All three study investigators reported having no financial conflicts regarding their research, which was conducted free of commercial support.
MUNICH – Getting less than 6 hours of sleep nightly on a regular basis or waking up multiple times was independently associated with increased risk of subclinical atherosclerosis in the Spanish PESA study, Fernando Dominguez, MD, reported at the annual congress of the European Society of Cardiology.
Moreover, a graded response was evident in PESA (Progression of Early Subclinical Atherosclerosis): The more times an individual typically awoke per night, the greater the number of atherosclerotic carotid or femoral artery territories documented on three-dimensional vascular ultrasound, added Dr. Dominguez of the Spanish National Center for Cardiovascular Research in Madrid.
the cardiologist said.
The cross-sectional PESA study, whose principal investigator was Valentin Fuster, MD, PhD, included 3,974 middle-aged Madrid bank employees free of known heart disease or history of stroke who wore a waistband activity monitor for a week to record sleep quantity and quality. They also underwent three-dimensional vascular ultrasound and measurement of coronary artery calcium.
PESA was one of several large studies presented at the meeting that focused on deviations from normal sleep as a marker for increased risk of cardiovascular disease and/or mortality. Of note, however, PESA was the only one to use activity monitoring technology to track sleep.
“It was essential to use objectively measured sleep variables, because they showed huge disparity with patients’ self-reports on sleep questionnaires,” Dr. Dominguez explained.
Indeed, while 10.7% of PESA participants self-reported sleeping less than 6 hours per night on the Sleep Habits Questionnaire, actigraphy showed the true rate was 27.1%.
Based on actigraphic findings, subjects were divided into tertiles based upon average hours of sleep per night, ranging from less than 6 to more than 8. They were also grouped in quintiles based upon their extent of fragmented sleep.
Subjects with short sleep were significantly older and more likely to have high blood pressure, a higher body mass index, and metabolic syndrome than those who averaged 7-8 hours of sleep. Individuals in the top quintile for sleep awakening were older and had higher prevalences of smoking and hypertension than those in the lowest quintile.
In multivariate analyses adjusted for these differences as well as for physical activity, depression, obstructive sleep apnea, daily calorie consumption, alcohol intake, and other potential confounders, subjects who slept less than 6 hours per night had a 27% greater volume of noncoronary plaque than those who slept 7-8 hours. They also had 21% more vascular territories laden with subclinical atherosclerosis. The risk of subclinical noncoronary atherosclerosis was greater among women who averaged less than 6 hours of sleep per night, representing a 48% relative risk increase in plaque volume, versus 21% in men.
At the other extreme, women who slept more than 8 hours per night had an 83% increased plaque volume, while men who slept that much had no increase in risk, compared with men who slept for 7-8 hours.
Subjects in the top quintile for sleep fragmentation had 34% more vascular territories affected by atherosclerosis than those in the lowest quintile. Their noncoronary plaque burden was 23% greater as well.
An 11-study meta-analysis
Epameinondas Fountas, MD, of the Onassis Cardiac Surgery Center in Athens, presented a meta-analysis of 11 prospective studies of the relationship between daily sleep duration and cardiovascular disease morbidity and mortality published within the past 5 years, reflecting burgeoning interest in this hot-button topic. Collectively, the meta-analysis totaled 1,000,541 adults without baseline cardiovascular disease who were followed for an average of 9.3 years.
In an analysis adjusted for numerous known cardiovascular risk factors, the Greek investigators found that short sleep duration as defined by a self-reported average of less than 6 hours per night was independently associated with a statistically significant and clinically meaningful 11% increase in the risk of diagnosis of fatal or nonfatal cardiovascular disease, compared with individuals who averaged 6-8 hours nightly. Moreover, those who averaged more than 8 hours of sleep per night were also at risk: they averaged a 32% increased risk in fatal or nonfatal cardiovascular events compared to normal 6- to 8-hour sleepers. Thus, 6-8 hours of sleep per night appears to be the sweet spot in terms of cardioprotection.
“Our message to patients is simple: Sleep well, not too long, nor too short, and be active,” Dr. Fountas said.
Numerous investigators have highlighted the pathophysiologic changes related to sleep deprivation that likely boost cardiovascular risk. These include activation of the sympathetic nervous system, increased inflammation, and disrupted glucose metabolism, he noted.
Swedes weigh in
Moa Bengtsson, a combined medical/PhD student at the University of Gothenburg (Sweden), presented a prospective study of 798 men who were 50 years old in 1993, when they underwent a physical examination and completed extensive lifestyle questionnaires that included average self-reported sleep duration. Among the 759 men still available for evaluation after 21 years, or nearly 15,000 person-years of followup, those who reported sleeping an average of 5 hours or less per night back at age 50 were 93% more likely to have experienced a major cardiovascular event by age 71 -- acute MI, stroke, coronary revascularization, heart failure hospitalization, or cardiovascular death -- compared with those who averaged 7-8 hours of shut eye.
The short sleepers had a higher prevalence of obesity, diabetes, hypertension, smoking, and physical inactivity than the men who slept 7-8 hours per night. However, these and other confounders were adjusted for in the multivariate analysis.
To place sleep abnormalities in context, Ms. Bengtssen observed that short sleep in the Gothenburg men was numerically a stronger independent risk factor for future cardiovascular events than obesity, which was associated with an 82% increase in risk, or even smoking, with a 70% increase in risk.
Men who averaged either 6 hours of sleep per night or more than 8 hours were not at increased cardiovascular risk over 21 years of followup, compared with those who slept 7-8 hours.
Like the other investigators, she noted that the studies presented at the meeting, despite their extensive adjustments for potential confounders, don’t prove a direct causal relationship between short sleep and increased cardiovascular risk. An informative next step in research, albeit a challenging one, would be to show whether improved long-term sleep habits favorably alter cardiovascular risk.
All three study investigators reported having no financial conflicts regarding their research, which was conducted free of commercial support.
REPORTING FROM THE ESC CONGRESS 2018