Suboptimal Sleep Linked to Greater Likelihood of Heart Disease

Aboubakari Nambiema, PhD, MPH

New findings suggest suboptimal sleep was associated with a higher likelihood of heart disease and stroke, with a higher healthy sleep score linked to lower risk.

Data suggest nine in ten patients do not get a good night’s sleep, with investigators estimating that 7 in 10 of these cardiovascular conditions could be prevented with proper sleep.

“Our study illustrates the potential for sleeping well to preserve heart health and suggests that improving sleep is linked with lower risks of coronary heart disease and stroke,” said lead study author Aboubakari Nambiema, PhD, MPH, INSERM. “We also found that the vast majority of people have sleep difficulties. Given that cardiovascular disease is the top cause of death worldwide, greater awareness is needed on the importance of good sleep for maintaining a healthy heart.”

The data were presented at the European Society of Cardiology Congress 2022 in Barcelona, Spain.

Most studies investigating the association between sleep habits and CVD have focused on a single sleep dimension, such as sleep duration and sleep apnea, and often measure sleep at baseline only. Nambiema and colleagues examined the association between the baseline sleep score and changes over time in the sleep score, and incident cardiovascular disease.

The study included 7,200 participants from the observational, community-based, prospective Paris Prospective Study III. Investigators recruited men and women aged 50 to 75 years and free of CVD in a preventive medical center between 2008 and 2011.

Each had undergone a standard physical examination and standard biological tests and were required to provide information on lifestyle, personal and family medical history, current health status, and medication use.

The sleep habits of participants were self-reported on validated questionnaires at baseline and two follow-up visits. The sleep dimensions were assigned a single point if optimal and zero point otherwise. Investigators computed a healthy sleep score ranging from 0 to 5 and reflected the number of optimal sleep dimensions.

The dimensions included early chronotype, sleep duration of 7 – 8 hour per day, never or rarely insomnia, no sleep apnea, and no frequent excessive daytime sleepiness. Additionally, investigators checked for incident coronary heart disease and stroke every two years for a total of 10 years.

At baseline, the study included 7203 participants (62% of men; mean age, 59.7 years) who were considered free of CVD and had complete data on sleep habits and covariates. Data show 10% of participants had an optimal sleep score (5) and 8% had a poor score (0 or 1).

Over a median follow-up of 8 years, 274 participants developed coronary heart disease or stroke. Investigators analyzed the association between sleep scores and cardiovascular events after adjusting for age, sex, alcohol consumption, occupation, smoking, body mass index, physical activity, cholesterol level, diabetes, and family history of heart diseases.

They determined that the risk of coronary heart disease and stroke decreased by 22% (HR, 0.78 [95% confidence interval, CI; 0.71 - 0.86]) per every 1 point rise in the sleep score at baseline. The data additionally suggest participants with a score of 5 had a 75% lower risk of heart disease or stroke, when compared to those with a score of 0 or 1.

With healthier sleep and an optimal sleep score, investigators determined that 72% of new cases of coronary heart disease and stroke might be avoided each year.

Then, over two follow-ups, data suggest 48% of participants were able to change their sleep score (25% decreased; 23% improved). Regarding the association between the change in score and cardiovascular events, they found a 1 point increment over time was associated with a 7% reduction in the risk of cardiovascular events.

“The low prevalence of good sleepers was expected given our busy, 24/7 lives,” Nambiema added. “The importance of sleep quality and quantity for heart health should be taught early in life when healthy behaviors become established. Minimizing night-time noise and stress at work can both help improve sleep.”

The abstract, “Healthy sleep score and incident cardiovascular diseases: the Paris Prospective Study III (PPS3),” was presented at ESC 2022.