Endothelial function and sleep: Associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep

Abstract

SummaryEndothelial function typically precedes clinical manifestations of cardiovascular disease and provides a potential mechanism for the associations observed between cardiovascular disease and sleep quality. This study examined how subjective and objective indicators of sleep quality relate to endothelial function, as measured by brachial artery flow-mediated dilation (FMD). In a clinical research center, 100 non-shift working adults (mean age: 36 years) completed FMD testing and the Pittsburgh Sleep Quality Index, along with a polysomnography assessment to obtain the following measures: slow wave sleep, percentage rapid eye movement (REM) sleep, REM sleep latency, total arousal index, total sleep time, wake after sleep onset, sleep efficiency, and apnea hypopnea index. Bivariate correlations and followup multiple regressions examined how FMD related to subjective (i.e., Pittsburgh Sleep Quality Index scores) and objective (i.e., polysomnography-derived) indicators of sleep quality. After FMD showed bivariate correlations with Pittsburgh Sleep Quality Index scores, percentage REM sleep, and REM latency, further examination with separate regression models indicated that these associations remained significant after adjustments for sex, age, race, hypertension, body mass index, apnea hypopnea index, smoking, and income (p's<0.05). Specifically, as FMD decreased, scores on the Pittsburgh Sleep Quality Index increased (indicating decreased subjective sleep quality) and percentage REM sleep decreased, while REM sleep latency increased (p's<0.05). Poorer subjective sleep quality and adverse changes in REM sleep were associated with diminished vasodilation, which could link sleep disturbances to cardiovascular disease.

Low sleep efficiency does not impact upper or lower limb vascular function in young adults

“…However, in contrast to the prior findings correlating low sleep quality and CVD risk, the present study revealed that young individuals exhibiting low sleep quality reported no significant or clinically meaningful differences in vascular function when compared with individuals exhibiting high sleep quality. These findings contradict previous research using both subjective (Pittsburgh Sleep Quality Index or the Sleep-Wake Experience List) and objective (polysomnography) sleep quality assessments in which low sleep quality was associated with reduced upper limb vascular function (Behl et al, 2014;Bonsen et al, 2015;Cooper et al, 2014). A notable difference between the present study and the aforementioned studies is the average age of participants.…”

Long Sleep Duration Associated With a Higher Risk of Increased Arterial Stiffness in Males

“…Thus, long sleep duration may be related to poor sleep quality, and poor sleep quality was found to be associated with insulin resistance, 31 alteration of hypothalamic-pituitaryadrenal system activity, 32 increased sympathetic activity, 33 and endothelial function impairment. 34,35 This may partially explain the association between long sleep duration and increased arterial stiffness. Further research is needed to explore their mechanism.…”

Insomnia as an Independent Predictor of Incident Cardiovascular Disease in HIV: Data From the Veterans Aging Cohort Study

“…[23][24][25] In addition, general population evidence supports associations between insomnia symptoms and biological mechanisms underlying CVD development, including systemic inflammation,31 altered coagulation,[32][33][34][35][36][37][38] and endothelial dysfunction. [55][56][57] There are study limitations that warrant consideration. First, our insomnia symptoms assessment was obtained only at baseline and relied on a single item.…”