Poor Sleep Health Linked to Significant Increase in Risk of Cardiovascular Disease

Soomi Lee, PhD

New research is providing clinicians with insight into the impact of sleep health on risk of cardiovascular disease across sex and race.

An analysis of data from nearly 7,000 adults from the Midlife in the United States study (MIDUS), results indicate problems with achieving optimal sleep was associated with a 54% increase in risk of cardiovascular disease, even after adjustment for sociodemographic and known risk factors.

“These findings show the importance of assessing ‘co-existing sleep health problems’ within an individual to capture the risk of heart disease. This is one of the first studies showing that, among well-functioning adults in midlife, having more sleep health problems may increase the risk of heart disease,” said lead author Soomi Lee, assistant professor of aging studies and director of the STEALTH lab at University of South Florida, in a statement. “The higher estimated risk in those who provided both self-report and actigraphy sleep data suggests that measuring sleep health accurately and comprehensively is important to increase the prediction of heart disease.”

Spurred by an interest in assessing the impact of sleep health on subsequent risk for cardiovascular disease, Lee and a team of colleagues from the University of South Florida designed their current study to examine these associations using multidimensional composite scores of sleep health among patients from MIDUS. From the MIDUS study, investigators identified 6820 adult participants with self-reported sleep characteristics and data related to history of cardiovascular disease.

Using this cohort, investigators created a pair of sleep health composite scores, with the first relying only on self-reported data and the other leveraging self-reported data and information from an actigraphy. Sleep composite cores were created with guidance from the Ru-SATED model. Investigators pointed out the self-report composite captured 5 of the 6 Ru-SATED dimensions and the actigraphy and self-report composite captured all 6 dimensions. Investigators pointed out the choice to use a pair of composite scores instead of a single score was to evaluate whether the associations between sleep health and cardiovascular disease could be replicated using different measures.

A diagnosis of heart disease was determined through responses to provider questions, with a list of possible diagnoses that included heart attack, angina, valve disease, septal defect, coronary artery disease, ischemia, arrhythmia, and heart failure, among others. Investigators noted hypertension was considered a risk factor of heart disease rather than cardiovascular disease for the purpose of analysis.

In a fully adjusted modified Poisson regression model, results pointed to a significant association of the self-report sleep health composite with risk of cardiovascular disease. Specifically, each 1-unit increase in poor sleep health was associated with a 54% (B=.43, SE=.09 [95% CI, 0.26-0.60], aRR=1.54; P <.001) greater risk of cardiovascular disease. When using the composite combining self-reported data and actigraphy, results suggested each 1-unit increase in poor sleep health was associated with a 141% (B=.88, SE=.22 [95% CI, 0.44-1.32] aRR, 2.41; P <.001) increase in risk of cardiovascular disease, after adjustment for all covariates.

Investigators highlighted significant differences in sleep health composites and cardiovascular disease were observed when stratifying by sex and race. Women had more sleep health problems based on self-reported data than their male counterparts while men were more likely to develop cardiovascular disease than women, but these factors did not influence the association between sleep health composites and risk of cardiovascular disease. When assessing the influence of race, results indicated all other races except non-Hispanic White individuals exhibited a weaker association between the actigraphy and self-report sleep health composite and risk of cardiovascular disease (B=−5.83, SE=1.77, [95% CI [−9.30 to −2.37]; P=.001).

“The current study reveals that having more sleep health problems may increase the risk of heart disease in middle adulthood. Results were consistent across our two models that used different sleep measures and different samples,” wrote investigators.

This study, “Sleep health composites are associated with the risk of heart disease across sex and race,” was published in Scientific Reports.