1. In this study, improved sleep quality was associated with significantly decreased systolic blood pressure and increased high-density lipoprotein levels after 24 months.
2. Increased time to sleep was also associated with decreased low-density lipoprotein levels, after 24 months.
Evidence Rating Level: 1 (Excellent)
Sleep has endocrinologic implications, which may impact cardio-metabolic health. However, sleep is not a well-recognized target for intervention when managing risk factors for cardio-metabolic disease. The MODERN trial (Management to Optimize Diabetes and mEtabolic syndrome Risk reduction via Nurse-led interventions) was designed to assess the impact of implementing lifestyle modifications on sleep quality and quantity, and thus cardio-metabolic risk factors, after 24 months.
This randomized controlled trial randomized 121 participants aged between 40-70 years from Colac or Shepparton, Australia who possessed 3 or more measurable cardio-metabolic risk factors (ex. hypertension, hyperglycemia, dyslipidemia). 59 participants were randomized to a lifestyle and health intervention group (received more individualized education, a physical activity program, and counselling on diet medication use), and 62 were randomized to a usual care group. Participants were excluded if they had a clinically established cardiovascular disease, life-threatening co-morbidities, or had renal disease. Primary outcomes assessed objective and subjective measures of diet, sleep (via actigraphy), physical activity, and cardio-metabolic risk (ex. blood pressure, blood glycemic levels).
Results at 24 months showed that both groups had improved markers of cardio-metabolic risk factors, with a greater reduction in blood pressure in the intervention group. Results also demonstrated that improved sleep efficiency significantly decreased systolic blood pressure and increased high-density lipoprotein levels. Furthermore, an increase in total sleep time significantly decreased low-density lipoprotein levels. Limitations were noted in the study, such as the use of actigraphy to assess sleep instead of polysomnography (the gold standard). Furthermore, this study sampled participants with normal sleep profiles, and therefore may not be generalizable to those who sleep poorly. Nonetheless, this study showed that improvements in sleep quality were associated with improved cardio-metabolic risk factors.
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