Decreased and disordered sleep associated with subclinical atherosclerosis

1. In this cross-sectional study of subclinical atherosclerosis and sleep quality, sleep duration less than six hours per night was associated with increased probability of higher atherosclerotic burden on three-dimensional vascular ultrasound.

2. The participants with the highest degree of sleep fragmentation also had a higher prevalence of multiple atherosclerosis-affected non-coronary arteries.

Evidence Rating Level: 3 (Average)

Study Rundown: Sleep is essential for maintaining overall health. Prior studies have shown associations between short or long sleep duration and important outcomes including hypertension, diabetes mellitus, stroke, coronary artery disease, and obesity. Many of these reports, however, relied on self-reported sleep duration and habits which may not accurately reflect true sleep length and character. This study sought to evaluate the relationship between objectively evaluated sleep quantity and quality and its relationship with subclinical atherosclerosis as evaluated by three-dimensional vascular ultrasound and coronary CT scans.  After adjusting for known cardiovascular risk factors, the study found that very short sleep duration (less than six hours) and highly fragmented sleep were both linked with increased burden of non-coronary atherosclerosis.

The main strengths of the study were the large population of participants with sleep activity objectively measured and the modern ultrasound techniques for evaluating atherosclerotic burden. The main limitations were the cross-sectional design which could not establish causality between poor sleep quality and atherosclerotic burden unknown, and the low prevalence of patients with long-sleep duration.

Click to read the study in JACC

Relevant Reading: Sleep Duration and Sleep Quality in Relation to 12-Year Cardiovascular Disease Incidence: The MORGEN Study

In-Depth [cross-sectional study]: This study was a cross-sectional analysis that used patients from the PESA-CNIC (Progression of Early Subclinical Atherosclerosis–Centro Nacional de Investigaciones Cardiovasculares)-Santander observational cohort that included employees of Santander Bank in Madrid if there were 40-54 years old. Participants were included if they were free of known cardiovascular disease, and were excluded if they had a known history of obstructive sleep apnea or did not have sleep or atherosclerosis examinations performed. Sleep quality was examined by using triaxial accelerometry to construct actigraphs and determine a sleep fragmentation index. Subclinical atherosclerosis was measured with 3D vascular ultrasound and coronary CT scans.

The study included 3,974 participants of whom 62.6% were men. Of the total cohort, 65.3% of individuals had less than the recommended duration of sleep. Very short sleep duration (<6 hours) was linked to increased risk of atherosclerotic burden (odds ratio: 1.27; 95% confidence interval: 1.06 to 1.52; p = 0.008). The highest quintile of sleep fragmentation index was also linked to an increased prevalence of multiple affected non-coronary territories (odds ratio: 1.34; 95% confidence interval: 1.09 to 1.64; p ¼ 0.006).

Image: PD

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