0868 Sleep Duration and Excess Heart Age among U.S. Adults

SLEEP, 2000

To examine the effects of obesity and frequent mental distress (FMD) on the relationship of sleep duration with coronary heart disease (CHD), stroke, and diabetes. Design: Cross-sectional study. Setting: Population-based surveillance. Participants: There were 54,269 adults age 45 y or older who completed the 2010 Behavioral Risk Factor Surveillance System survey in 14 states. Results: Nearly one third (31.1% or an estimated 11.1 million) of respondents age 45 y and older reported being short sleepers (≤ 6 h), 64.8% being optimal sleepers (7-9 h), and 4.1% being long sleepers (≥ 10 h) in a 24-h period. Compared with the optimal sleep duration, both short and long sleep durations were significantly associated with obesity, FMD (mental health was not good ≥ 14 days during the past 30 days), CHD, stroke, and diabetes after controlling for sex, age, race/ethnicity, and education. The U-shaped relationships of sleep duration with CHD, stroke, and diabetes were moderately attenuated by FMD. The relationship between sleep duration and diabetes was slightly attenuated by obesity. Conclusions: Sleep duration had U-shaped relationships with leading chronic diseases. Further prospective studies are needed to determine how mental health and maintenance of a normal weight may interact with sleep duration to prevent chronic diseases.

Clinical Cardiology, 2013

Background: Data regarding the associations between sleep duration and clinical cardiovascular (CV) events are limited. We aimed to analyze any associations between self-reported sleep duration and CV events.

2008

JAMA Network Open, 2020

IMPORTANCE Single self-reported measures of sleep duration are associated with adverse health outcomes; however, long-term patterns of self-reported sleep duration and their association with cardiovascular events (CVEs) and all-cause mortality remain unknown. OBJECTIVE To determine whether trajectories of long-term vs single-measure sleep duration are associated with subsequent risk of CVEs and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS The Kailuan study is a prospective, population-based cohort study that began in 2006. The present cohort included 52 599 Chinese adults without atrial fibrillation, myocardial infarction, stroke, or cancer to 2010. Trajectories in sleep duration from

Sleep Medicine, 2017

Cardiovascular disease (CVD) is the leading cause of mortality in the United States accounting for 1 out of every 3 deaths. Additionally, 43.9% of the population is expected to have some form of cardiovascular disease by the year 2030, with direct and indirect costs expected to rise upwards of 58 percent. To successfully prevent cardiovascular disease conditions such as myocardial infarction, coronary heart disease, and stroke, research must be done to identify risk factors, both modifiable and non-modifiable. In the existing literature, sleep duration as a risk factor for cardiovascular disease conditions has shown inconsistent associations. According to the National Sleep Foundation, the average adult needs between 7 and 9 hours of sleep per day, yet 50-70 million adults in the U.S. have some form of chronic sleep disorder. Furthermore, both short and long sleep duration is associated with known cardiovascular disease risk factors such as diabetes, hypertension, obesity, high cholesterol, depression, and overall metabolic dysfunction. This study aimed to determine if an association exists between deficient, and/or excessive sleep duration and myocardial infarction, coronary heart disease, and stroke, in the state of Nevada. The 2013 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Nevada was assessed utilizing multiple logistic regression analysis in order to quantify risk. Results from the multiple logistic regression identified a total of twelve predictors of cardiovascular conditions in the final model. It was also determined that both deficient and excessive sleep duration was significantly associated with myocardial infarction, coronary heart disease or angina, and stroke, throughout the study, even after adjustment iv for covariates. The findings from this study can be used as additional evidence to encourage further research on improving sleep by developing future treatment therapies, and recommendations, that may help lower the risk of cardiovascular disease conditions. v Acknowledgements I would like to express my appreciation, gratitude, and utmost respect, to my committee chair and former employer Dr. Sheniz Moonie, who has continually helped guide me through this process. Without her supervision and direction, this thesis would not have been possible. Furthermore, I would like to thank Dr. Moonie's former colleague and statistician guru, Dr. Chad Cross, for his quick replies and wealth of knowledge on complex survey sampling. Also, I'd like to express gratitude to the Nevada State Health Division for allowing access to the Behavioral Risk Factor Surveillance System (BRFSS).

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.

European Heart Journal, 2011

To assess the relationship between duration of sleep and morbidity and mortality from coronary heart disease (CHD), stroke, and total cardiovascular disease (CVD).

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.

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.

International journal of cardiology, 2016

Most previous studies on sleep duration and coronary heart disease (CHD) have been small and have inadequately controlled for cardiovascular risk factors and chronic diseases. Therefore, our aim was to prospectively examine the associations of sleep duration with CHD while accounting for these factors. Prospective cohort study of 392 164 adults at age 20years or older who attended a health check-up program from 1994 to 2011 in Taiwan and who have information on sleep duration, sleep medications and potential confounders. Participants answered the question: &quot;How long do you sleep for?&quot;-there were four response categories: (a) 0-4h; (b) 4-6h; (c) 6-8h and (d) &gt;8h. The participants were then followed for CHD mortality from the Taiwanese cause-of-death register. When compared to those who slept 6-8h per night, the risk of dying from CHD was increased by 34% (HR 1.34, 95% Confidence Interval [CI] 0.87-2.07) and 35% (HR 1.35, 95% CI 1.11-1.65) in those who slept less than 4h ...