Poor sleep can increase cardiovascular and stroke risk

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New research confirms that good sleep is essential for cardiovascular health. Image credit: Janine McLaren/EyeEm/Getty Images.
  • The researchers examined the relationship between cardiovascular risk and sleep quality.
  • They found that improved sleep quality is linked to lower cardiovascular risk.
  • They noted that increased awareness of sleep quality and quantity could improve sleep quality and potentially reduce cardiovascular risk.

According to the American Sleep Association, 50 to 70 million adults in the United States suffer from a sleep disorder. Of these, 25 million suffer from obstructive sleep apnea (OSA), which is when the muscle at the back of the throat relaxes too much to allow regular breathing.

Studies To display that OSA is linked to multiple cardiovascular diseases. Research also indicates that healthy sleep habits reduce cardiovascular risk, even in people at high genetic risk.

Most studies examining the link between sleep quality and cardiovascular risk have focused on one dimension of sleep: sleep duration or sleep apnea. The combined effect of the multiple dimensions of sleep on cardiovascular health therefore remains understudied.

Recently, researchers at the French National Institute of Health and Medical Research in Paris, France, studied the joint effect of several sleep habits on the incidence of cardiovascular disease.

They found that a healthier overall sleep score was linked to lower cardiovascular and stroke risk.

They presented their findings at this year’s European Society of Cardiology (ESC) congress.

For the study, the researchers analyzed data collected between 2008 and 2011 from 7,203 men and women between the ages of 50 and 75. All were free of cardiovascular disease at the start of the study.

Each participant underwent a physical examination and various biological tests. They also provided lifestyle and medical history information. Researchers assessed participants’ sleep patterns via a questionnaire, looking at:

  • sleep duration
  • insomnia
  • early waking chronotype – known as a “morning person”
  • Sleep Apnea
  • subjective daytime sleepiness.

Each dimension received a score of 1 or 0. Criteria for scoring 1 or “healthy” included:

  • early chronotype
  • sleep duration of 7 to 8 hours per day
  • little or no insomnia
  • no sleep apnea
  • no frequent daytime sleepiness.

Participants’ overall sleep scores ranged from 0 to 5. Of the participants, 6.9% had a sleep score of 0 or 1, and 10.4% had an optimal sleep score of 5.

After a median follow-up of 8 years, the researchers noted that participants with a score of 5 – optimal sleep – had a 74% lower risk of cardiovascular disease than those with the poorest sleep quality.

They added that each one-point increase in healthy sleep score corresponded to a 22% reduction in cardiovascular risk.

When asked what might explain the link between lack of sleep and increased risk of cardiovascular disease and stroke, Dr Aboubakari Nambiema, postdoctoral researcher at Paris Cité University in France, one of the study authors, said Medical News Today that there is currently no definitive answer.

He noted that the American Heart Association recently updated its “The essentials of life 8“cardiovascular health indicator to include sleep duration and that there are many possible mechanisms underlying the link between sleep quality and heart health.

In conversation with DTMDr. Saurav Luthra, of the Division of Pulmonary, Critical Care, and Sleep Medicine at the University of Kansas Health System, explained some of these potential mechanisms:

“[Current research suggests] that sound sleep is vital for resting the heart and brain. [In the absence of sleep], there may be increased inflammation, release of stress hormones, and decreased removal of toxins from the brain. These can trigger fluctuations in heart rate and increased blood pressure at night. We believe this can lead to heart conditions such as uncontrolled blood pressure – hypertension, irregular heart rhythms such as atrial fibrillation – and possibly poor cognition [or] memory difficulty.

“Poor sleep, if secondary to underlying sleep apnea, can also lead to an increased risk of stroke/blood clots from inflammation as well as low oxygen levels at night and thickening blood, which results from a chronically low level of oxygen in the blood,” he added. .

Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, Calif., who was not involved in the study, added that poor-quality sleep disrupts the sympathetic nervous system – the “fight or flight” response of the body.

“Increased sympathetic nervous system tone is responsible for higher circulation of catecholamines, which are hormones that lead to increased heart rate, blood pressure, and vascular resistance,” he said. added.

“Indirectly, poor sleep contributes to the dysregulation of hormones involved in hunger. This contributes to obesity, which is a significant risk factor for cardiovascular disease,” he noted.

Dr. Sanjay Patel, professor of medicine, epidemiology, and clinical and translational sciences at the University of Pittsburgh, not involved in the study, said DTM that other factors could also be responsible for the observed results.

“We know that poverty leads to poorer quality sleep and that people with lower socio-economic conditions have a much higher risk of heart disease and stroke. Likewise, anything that increases stress in life – having a sick child, having to care for an older relative, having a very stressful job – will lead to poorer quality of sleep and also increase the risk of heart disease. and stroke,” Dr. Patel explained. .

“We cannot be completely sure from this study whether the associations that were found are caused by lack of sleep or related to some other factor,” he noted.

The researchers concluded that better sleep quality across multiple dimensions is linked to lower cardiovascular and stroke risk.

Asked about the study’s limitations, Dr. Daniela Grimaldi, an assistant research professor at Northwestern University’s Center for Circadian and Sleep Medicine, who was not involved in the study, said DTM:

“A limitation could be represented by the fact that these results come from self-reported measures of sleep quality; it will be important for future studies to confirm these findings using subjective and objective measures of sleep quality.

Dr. Fiona Barwick, clinical associate professor of psychiatry and behavioral sciences and sleep medicine at Stanford University, not involved in the study, explained some key issues with self-reported measures of sleep quality.

“Self-reported estimates of total sleep time can be inaccurate, with people with insomnia typically underestimating total sleep time, and people with good sleep often overestimating total sleep time,” she said. note. “Sleep apnea is not always recognized by those who suffer from it unless they complete an overnight sleep study at home or in a laboratory, because the obvious symptoms of sleep apnea such as snoring, the panting or difficulty in breathing observed is not always present.”

“Even excessive daytime sleepiness can be masked by caffeine consumption,” added Dr. Barwick. “Self-report measures may also be inaccurate on some lifestyle factors because people are more likely to under-report how much they smoke, drink or exercise, in an effort to create a positive impression. Inaccuracies in self-reported data can make it difficult to get a clear and definitive picture of the relationship between sleep and health risks.

Dr. Damien Stevens, medical director of the University of Kansas Health System Sleep Laboratory, who was not involved in the study, added that cause doesn’t always mean effect.

“Just because they happen together doesn’t mean one causes the other. For example, some patients may start sleeping poorly because they have chest pain or other symptoms of heart disease. , so rather than poor sleep leading to heart problems, poor sleep can sometimes be a sign of heart disease,” he noted.

DTM also asked Dr. Nour Makarem, assistant professor of epidemiology at Columbia University, not involved in the study, how to improve sleep quality. She noted that prioritizing sleep is important and that 7-8 hours of sleep per night is ideal for heart health.

“It’s also important to practice good sleep hygiene, which is to put yourself in the best position to sleep well by optimizing your sleep schedule, bedtime routine, and sleep environment,” a- she noted.

“Stick to a consistent sleep schedule, i.e. try to go to bed and wake up at the same time every day, and try to keep the same sleep schedule on weekdays and weekends to avoid disrupt the sleep-wake rhythm of your biological clock. Use the hour before bed to relax and optimize your sleeping environment by making your bedroom comfortable, quiet, cool and dark,” Dr. Makarem advised.

“Get rid of distractions like bright light and noise. For example, use heavy curtains or an eye mask to block light from interrupting your sleep, and avoid bright light sources such as computers, televisions, and telephones. Also try to muffle any noise by using earplugs or a white noise machine, and avoid stimulants such as nicotine and caffeine,” she continued.

Dr. Nambiema concluded that from a public health perspective, increasing health awareness and literacy about sleep quality is essential.

He said that “[t]it could indeed start early in life, and primary school could represent a wonderful window of opportunity for this. It is important to note that it should be a continuous education program and adapted to each level of the school. »

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