Association of Subjective and Objective Sleep Duration as well as Sleep Quality with Non-Invasive Markers of Sub-Clinical Cardiovascular Disease (CVD): A Systematic Review

Abstract

Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity & mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remain less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD.Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality Index (PSQI) or via objective methods, as actigraphy or polysomnography or by both. Among subclinical CVD measures, coronary artery calcium (CAC) was measured by electron beam computed tomography, Carotid intima-media thickness (CIMT) measured by high-resolution B-mode ultrasound on carotid arteries, endothelial/microvascular function measured by flow mediated dilation (FMD) or peripheral arterial tone (PAT) or iontophoresis or nailfold capillaroscopy, and arterial stiffness measured by pulse wave velocity (PWV) or ankle brachial index (ABI).Results: Subjective short sleep duration was associated with CAC and CIMT, but variably associated with endothelial dysfunction (ED) and arterial stiffness; however, subjective long sleep duration was associated with CAC, CIMT and arterial stiffness, but variably associated with ED. Objective short sleep duration was positively associated with CIMT and variably with CAC but not associated with ED. Objective long sleep duration was variably associated with CAC and CIMT but not associated with ED. Poor subjective sleep quality was significantly associated with ED and arterial stiffness but variably associated with CAC and CIMT. Poor objective sleep quality was significantly associated with CIMT, and ED but variably associated with CAC.Conclusions: Overall, our review provided mixed results, which is generally in line with published literature, with most of the studies showing a significant relationship with subclinical CVD, but only some studies failed to demonstrate such an association. Although such mechanistic relationship needs further evaluation in order to determine appropriate screening strategies in vulnerable populations, this review strongly suggested the existence of a relationship between abnormal sleep duration and quality with increased subclinical CVD burden.

Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

“…However, the effects of perceived sleep quality and insomnia in the absence of sleep deprivation on endothelial function are less clear. The lack of association between sleep quality and insomnia score, and brachial artery FMD in our study in a subset of women who slept more than 7 hours/night is in accordance with previous reports where FMD has been mostly unaffected by sleep quality in the absence of curtailed sleep duration 37, 38, 39, 40. We tested mRNA expression of pro‐inflammatory genes ICAM‐1 and VCAM‐1 , which are considered essential for transendothelial migration of monocytes into the arterial wall; however, no significant correlation with perceived sleep quality or ISI score was observed.…”

Shift work with and without night work as a risk factor for fatigue and changes in sleep length: A cohort study with linkage to records on daily working hours

“…Shift work and ageing have both been associated with increased need for recovery in earlier studies (Gommans, Jansen, Stynen, De Grip, & Kant, ; Jansen, Kant, Van Amelsvoort, Nijhuis, & Van Den Brandt, ), and increased need for recovery, in turn, is a strong predictor of subsequent cardiovascular disease (Van Amelsvoort, Kant, Bultmann, & Swaen, ) and even cardiovascular death (Kivimäki et al., ). Both shortened and extended objective sleep durations have been reported to be linked to cardiovascular diseases and its early indicators (Aziz et al., ; Cappuccio et al., ).…”

Quality Of Sleep In Ckd Patients On Chronic Hemodialysis And The Effect Of Dialysis Shift

“…Lack of sleep and poor sleep quality has been associated in prior studies with long-term health risks like type 2 diabetes, 12 hypertension, 13 cardiovascular risks, 14,15 depression, 16 anxiety, increased morbidity and mortality. 3 Sleep is also an important predictor of quality of life.…”