Association of sleep duration and quality with subclinical atherosclerosis

Authors: DOMINGUEZ, FERNANDO - National Center For Cardiovascular Research(CNIC); FUSTER, VALENTIN - National Center For Cardiovascular Research(CNIC); FERNANDEZ-ALVIRA, JUAN - National Center For Cardiovascular Research(CNIC); FERNANDEZ-FRIERA, LETICIA - National Center For Cardiovascular Research(CNIC); LOPEZ-MELGAR, BEATRIZ - National Center For Cardiovascular Research(CNIC); BLANCO-ROJO, RUTH - Imdea Institute; FERNANDEZ-ORTIZ, ANTONIO - National Center For Cardiovascular Research(CNIC); GARCIA-PAVIA, PABLO - University Hospital Puerta De Hierro, Majadahonda; SANZ, JAVIER - National Center For Cardiovascular Research(CNIC); MENDIGUREN, JOSE - Banco De Santander; IBANEZ, BORJA - National Center For Cardiovascular Research(CNIC); BUENO, HECTOR - National Center For Cardiovascular Research(CNIC); LARA-PEZZI, ENRIQUE - National Center For Cardiovascular Research(CNIC); ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of the American College of Cardiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/12/2018
Publication Date: 1/22/2019
Citation: Dominguez, F., Fuster, V., Fernandez-Alvira, J.M., Fernandez-Friera, L., Lopez-Melgar, B., Blanco-Rojo, R., Fernandez-Ortiz, A., Garcia-Pavia, P., Sanz, J., Mendiguren, J.M., Ibanez, B., Bueno, H., Lara-Pezzi, E., Ordovas, J.M. 2019. Association of sleep duration and quality with subclinical atherosclerosis. Journal of the American College of Cardiology. 73(2):134-144. https://doi.org/10.1016/j.jacc.2018.10.060.
DOI: https://doi.org/10.1016/j.jacc.2018.10.060

Interpretive Summary: Previous research has suggested a link between poor sleep and health problems like high blood pressure, diabetes, and stroke. Detecting the link between sleep and those diseases, though, has been complicated by the fact that most studies are retrospective, so the results are susceptible to errors in memory. The purpose of this study was to evaluate the association of objectives measures of sleep with subclinical atherosclerosis in an asymptomatic middle-aged population and investigate interactions among sleep, conventional risk factors, psychosocial factors, dietary habits, and inflammation. This study included 3,974 bank employees in Spain from the PESA CNIC-Santander Study, which uses imaging techniques to detect the prevalence and rate of progression of subclinical vascular lesions in a population with an average age of 46 years. All participants were without known heart disease, and two-thirds were men. All participants wore an actigraph, a small device that continuously measures activity or movement, for seven days to measure their sleep. They were divided into four groups: those who slept less than six hours, those who slept six to seven hours, those who slept seven to eight hours and those who slept more than eight hours. The participants underwent 3D vascular ultrasound, and cardiac computed tomography (CT) scans to look for vascular disease. We found that when traditional risk factors for vascular disease were considered, participants who slept less than six hours were 27 percent more likely to have atherosclerosis throughout the body compared with those who slept seven to eight hours. Similarly, those who had a poor quality of sleep were 34 percent more likely to have atherosclerosis compared with those who had a good quality of sleep. Quality of sleep was defined by how often a person woke during the night, and the frequency of movements during the sleep which reflect the sleep phases. This is the first study to use objective sleep measurements and advanced imaging techniques to look for a link between sleep and atherosclerosis in healthy subjects. These results may lead to better preventative care for cardiovascular diseases.

Technical Abstract: BACKGROUND: Sleep duration and quality have been associated with increased cardiovascular risk. However, large studies linking objectively measured sleep and subclinical atherosclerosis assessed in multiple vascular sites are lacking. OBJECTIVES: The purpose of this study was to evaluate the association of actigraphy-measured sleep parameters with subclinical atherosclerosis in an asymptomatic middle-aged population, and investigate interactions among sleep, conventional risk factors, psychosocial factors, dietary habits, and inflammation. METHODS: Seven-day actigraphic recording was performed in 3,974 participants (age 45.8 +/- 4.3 years; 62.6% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study. Four groups were defined: very short sleep duration <6 h, short sleep duration 6 to 7 h, reference sleep duration 7 to 8 h, and long sleep duration >8 h. Sleep fragmentation index was defined as the sum of the movement index and fragmentation index. Carotid and femoral 3-dimensional vascular ultrasound and cardiac computed tomography were performed to quantify noncoronary atherosclerosis and coronary calcification. RESULTS: When adjusted for conventional risk factors, very short sleep duration was independently associated with a higher atherosclerotic burden with 3-dimensional vascular ultrasound compared to the reference group (odds ratio: 1.27; 95% confidence interval: 1.06 to 1.52; p = 0.008). Participants within the highest quintile of sleep fragmentation presented a higher prevalence of multiple affected noncoronary territories (odds ratio: 1.34; 95% confidence interval: 1.09 to 1.64; p = 0.006). No differences were observed regarding coronary artery calcification score in the different sleep groups.