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Weekend Warriors Be Warned: Irregular Sleep Patterns Linked to CV Risk
The more variable a person's sleep schedule, the greater his or her risk of cardiovascular disease (CVD), data from the Multi-Ethnic Study of Atherosclerosis (MESA) showed.
A larger range in individual sleep duration and sleep timing across 7 days of wrist actigraphy was associated with significantly more CVD events over a median 4.9 years of follow-up (P=0.002 for both trends).
For example, CVD risk was more than doubled for those whose standard deviation (SD) in sleep duration was greater than 120 minutes (vs ≤60 min) and for those whose time at sleep onset varied with a SD of more than 90 minutes (vs ≤30 minutes).
Every 1-hour increase in sleep duration SD was associated with 36% higher CVD risk (P=0.02). For ever 1-hour increase in sleep timing SD, there was an 18% increase in risk (P=0.002).
Results persisted even when shift workers were excluded, a team led by Tianyi Huang, ScD, MSC, of Brigham and Women's Hospital in Boston, reported in the Journal of the American College of Cardiology.
"Although rotating night shift work is considered as a more severe form of circadian disruption than sleep irregularity, the increased CVD risk associated with sleep irregularity in this study appeared stronger compared with previous reports of shift work and CVD," study authors wrote.
"Most importantly, the results remained robust after considering multiple established CVD risk factors and conventional measures of sleep quantity and quality, which suggested that irregular sleep duration and timing might be novel and independent risk factors for CVD," they added.
Dysfunctional sleep thus could be one mechanism that underlies the association between modern lifestyle and poor cardiovascular outcomes, commented Olaf Oldenburg, MD, of Ludgerus-Kliniken Münster, Germany, and Jens Spiesshoefer, MD, of the Institute of Life Sciences at Scuola Superiore Sant'Anna in Pisa, Italy, and University Hospital Muenster, Germany.
"In modern society, both the quantity and quality of sleep are negatively influenced by factors such as longer hours of work, more shift work, artificial light and cell phones, all leading to self-reported daytime symptoms such as fatigue, tiredness, and sleepiness," they wrote in an accompanying editorial.
Yet modern technology, in the form of wearable devices and mobile apps, may also present opportunities for future interventions designed to reduce CVD incidence via sleep consistency targets, Huang and colleagues suggested.
Their study included people who were free of CVD both at entry to the MESA study and when asked to join the sleep study. After 40% of participants declined to participate and people were excluded for having developed CVD or insufficient actigraphic recordings, the investigators were left with 1,992 individuals and 111 CVD events during the study period.
Irregular sleep was "highly prevalent" in the study, authors said: 39.5% of patients had sleep duration SD >90 min and 25.6% had sleep-onset timing SD >90 min.
People with these sleep patterns tended to have worse cardiometabolic risk profiles at baseline.
Modest sample size and relatively short-follow-up were two limitations of the study, the investigators acknowledged. Residual confounding also could not be excluded because of the study's observational design.
"Dysfunctional sleep likely is by far the most prevalent comorbidity in CVD. This makes it essential to explore the nature of sleep, but this is reliant on the enthusiasm of clinician scientists," according to the editorialists.
Three areas of research should be pursued, they said: analysis of big data for more information on the sleep-CVD relationship, study of conservative interventions to improve sleep quality in people with CVD, and testing of whether altered circadian rhythms might translate to unfavorable changes in 24-hour sympathovagal and neurohormonal balance -- and ultimately, to CVD.
The study was supported by contracts with the National Heart, Lung, and Blood Institute and by grants from the National Center for Advancing Translational Sciences.
Huang and Oldenburg had no disclosures.
Spiesshoefer reported received travel grants and lecture honoraria from Boehringer Ingelheim and Chiesi.
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