Insufficient sleep and cardiovascular disease

Abstract

In aggregate, studies conducted across multiple settings in diverse populations indicate that extremes of sleep duration are associated with numerous cardiovascular risk factors, including hypertension. However, even after considering these risk factors, the predominance of data indicates that extreme sleep duration is also associated with clinical cardiovascular disease and cardiovascular mortality. The overall “dose–response” for these associations is not clear. While some studies suggest monotonic associations, others suggest a J- or U-shaped distribution. Also, while the most extreme durations (e.g., less than 5 or more than 10 h of sleep per night) have been fairly consistently associated with adverse cardiovascular outcomes, the magnitude of effect of less extreme deviations from 7 to 8 h per night is less apparent. The sources of population heterogeneity in susceptibility to the effects of sleep deprivation also are not well understood. While some data indicate stronger effects in women compared to men, it is plausible that such differences could relate to measurement or greater misclassification of exposures in men. A further understanding of the inter-relationship of sleep patterns with other important health behaviors (activity patterns and diet) and more comprehensive assessments of sleep in terms of duration, quality, timing, and symptoms may help further clarify which aspects of sleep are most important in the pathogenesis of cardiovascular disease.