Sleep Duration, Snoring Habits, and Cardiovascular Disease Risk Factors in an Ethnically Diverse Population

Abstract

Background Lack of sleep has been associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality, but the mechanisms are not fully understood. Prior research has often been conducted in select populations and has not consistently adjusted for confounders, especially psychosocial factors. Objective The aims of this study were to assess the association between sleep habits and established risk factors for CVD and to evaluate potential interactions by race and gender. Methods Participants were part of a CVD screening and educational outreach program in New York City. Free-living men older than 40 years and women older than 50 years (n = 371, mean age = 60 years, 57% women, 60% racial/ethnic minorities) were systematically assessed for CVD risk (including traditional, lifestyle, and psychosocial risk factors) and completed a standardized questionnaire regarding sleep habits (including sleep duration and snoring). Lipids were analyzed by validated finger-stick technology. Stress at work and at home was assessed using a validated screening tool from the INTERHEART study. Associations between participants’ sleep habits and CVD risk factors/demographic factors were assessed using multivariable logistic regression. Results The proportion of participants who reported sleeping less than 6 hours per night on average was 28%, and 52% of participants reported snoring. Sleeping less than 6 hours per night was significantly (P < .05) associated with female gender, being single, increased stress at home, increased financial stress, and low-density lipoprotein cholesterol (LDL-C) level. Gender modified the association between sleep duration and LDL-C level (P = .04): Sleeping less than 6 hours per night was significantly associated with reduced LDL-C level among women and increased LDL-C level among men. Snoring was significantly associated with low high-density lipoprotein cholesterol (HDL-C) level (<40 mg/dL for men/<50 mg/dL for women), being married, increased stress at work and at home, less than 30 minutes of exercise per day, less than 5 servings of fruits and vegetables per day, and being overweight/obese (body mass index ≥25 kg/m2). The association between snoring and low HDL-C level remained significant in logistic regression models adjusted for demographic confounders (odds ratio, 1.83; 95% confidence interval, 1.06–3.19) but not after adjustment for body mass index greater than 25 kg/m2. Conclusions Sleeping less than 6 hours per night was associated with several traditional and psychosocial CVD risk factors, and snoring was associated with low HDL-C level, likely mediated through overweight/obesity. These data may have significance for health care providers to identify individuals who may be at increased CVD risk based on sleep habits.

Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis

“…[8][9][10][11] However, there has hitherto been little speculation on the potential mechanisms underlying the associations of long sleep duration with morbidity and mortality. Rather, one vigorous argument has focused on sleep apnea, which could confound the associations because individuals with this disorder spend more time or an excessive amount of time asleep to compensate for the fragmented nature of their sleep.…”

“…4 Evidence has suggested that the average sleep duration declined by approximately 18 min from 1972 to 2005, especially in working-age men; 5 and the percentage of short sleepers has increased significantly among full-time workers from 1975 to 2006. 6 During the past couple of decades, many studies have reported the association of short or long sleep duration with a series of negative health outcomes, including mortality, 7-9 cardiovascular disease, 10,11 selfrated health 12,13 and chronic diseases such as type 2 diabetes, metabolic syndrome, obesity, osteoporosis. [14][15][16][17][18] Recently, growing evidence has suggested that short or long sleep duration might be associated with hypertension risk.…”

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

“…Women adopt such behavior in disproportionately greater numbers in part because of lifelong demands on them as caregivers, first to their children and later to ailing and/or elderly family members 8, 9. Furthermore, psychosocial factors may disproportionally impact sleep among women compared with men.…”

Sleep duration and cardiovascular responses to stress in undergraduate men

“…Sleep duration and stress are often inversely related. Short sleep may be more likely to occur in the midst of heightened psychological stress (Kashani, Eliasson, & Vernalis, 2012;Mosca & Aggarwal, 2012;Roberts, Roberts, & Xing, 2011), and events on days preceded by a shorter night of sleep are described as more distressing (Hamilton et al, 2008;Kumari et al, 2009). In addition to subjective reports of stress, there is also evidence that sleep loss may influence neural modulation of the autonomic stress response.…”