Objective Sleep Efficiency Predicts Cardiovascular Disease in a Community Population: The Sleep Heart Health Study

Abstract

Background There was little evidence about the role of objective sleep efficiency (SE) in the incidence of major cardiovascular disease (CVD) events. The purpose of this study was to investigate the correlation between objective SE and CVD based on polysomnography. Methods and Results A total of 3810 participants from the SHHS (Sleep Heart Health Study) were selected in the current study. CVD was assessed during an almost 11‐year follow‐up period. The primary composite cardiovascular outcome was major adverse cardiovascular events, defined as CVD mortality, congestive heart failure, myocardial infarction, and stroke. The secondary composite cardiovascular outcome was major adverse cardiovascular event plus revascularization. Objective measured SE, including SE and wake after sleep onset, was based on in‐home polysomnography records. Cox regression analysis was used to explore the association between SE and CVD. After multivariate Cox regression analysis, poor SE (<80%) was significantly associated with primary (hazard ratio [HR], 1.338; 95% CI, 1.025–1.745; P =0.032) and secondary composite cardiovascular outcomes (HR, 1.250; 95% CI, 1.027–1.521; P =0.026); it was also found to be a predictor of CVD mortality (HR, 1.887; 95% CI, 1.224–2.909; P =0.004). Moreover, wake after sleep onset of fourth quartile (>78.0 minutes) was closely correlated with primary (HR, 1.436; 95% CI, 1.066–1.934; P =0.017), secondary composite cardiovascular outcomes (HR, 1.374; 95% CI, 1.103–1.712; P =0.005), and CVD mortality (HR, 2.240; 95% CI, 1.377–3.642; P =0.001). Conclusions Poor SE and long wake after sleep onset, objectively measured by polysomnography, were associated with the increased risk of incident CVD.

Sleeping Late Increases the Risk of Myocardial Infarction in the Middle-Aged and Older Populations

“…Sleep has been identified as a public behavioral lifestyle health which emphasizing the impact of poor sleep on the prevalence of disease (18). Sleep quality, sleep habits, sleep duration and sleep architecture were found to be closely related to cardiovascular disease (19)(20)(21). Moreover, sleeping late was found to be associated with several MI risk factors.…”

Relations of Lifestyle Behavior Clusters to Dyslipidemia in China: A Compositional Data Analysis

“…Furthermore, several studies have shown that too long or too short sleep duration increased the risk of CVD, stroke, hypertension, diabetes, and metabolic syndrome [40][41][42]. Except for sleep duration, other aspects of sleep were proved to be related to chronic non-communicable diseases [43][44][45]. A study revealed the finding that sleep fragmentation was associated with higher blood glucose levels among African-Americans, and poor sleep efficiency and long wake after sleep onset increased risk of incident CVD [43].…”

“…Except for sleep duration, other aspects of sleep were proved to be related to chronic non-communicable diseases [43][44][45]. A study revealed the finding that sleep fragmentation was associated with higher blood glucose levels among African-Americans, and poor sleep efficiency and long wake after sleep onset increased risk of incident CVD [43]. As a result, comprehensive assessment of sleep should be conducted to explore its relationship with health outcomes.…”

Sleep Efficiency is Inversely Associated with Brachial Artery Diameter and Morning Blood Pressure in Midlife Adults, with a Potential Sex-Effect

“…[4][5][6][7] Furthermore, an 11-year longitudinal study from the Sleep Heart Health Study cohort (n = 3810) showed a strong inverse association between sleep efficiency, determined via at-home overnight polysomnography, and major adverse CV events. 8 However, the physiological mechanisms by which poor sleep efficiency increases CV disease risk are not well understood.…”