Sleep habits affect CV outcomes, body composition
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Two studies presented at the American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions demonstrated that optimal sleep patterns may reduce CVD risk and weight.
In one study, researchers found that adding healthy sleep behaviors to metrics of ideal heart health improved predictions of CVD incidence and prevalence.
In another, researchers found that women who went to bed at the same time daily had reduced adipose tissue compared with women who did not.
Sleep and CVD risk
Nour Makarem, PhD, associate research scientist in the division of cardiology at Columbia University Irving Medical Center, and colleagues compared the AHA’s Life’s Simple 7 score with four alternate scores that combined the Life’s Simple 7 score with sleep health metrics in 1,920 adults (mean age, 70 years) from the MESA Sleep Study.
The Life’s Simple 7 score includes tobacco use, body weight, diet, physical activity, cholesterol, BP and glucose levels. Of the alternate scores, one included sleep duration, one included sleep characteristics linked in the literature to CVD and two included sleep characteristics linked in the MESA cohort to CVD.
“Accumulating evidence has linked aspects of sleep including sleep duration, sleep quality, variability in sleep patterns, and sleep disorders to cardiovascular disease risk. In addition, poor sleep is associated with developing risk factors for cardiovascular disease such as obesity, type 2 diabetes, and hypertension. However, sleep has not been accorded the same level of attention as other health behaviors in public health guidance or clinical practice to promote CV health. It is also not currently included as a metric of CV health in the AHA’s Life’s Simple 7,” Makarem told Healio. “We undertook this study to determine whether the inclusion of sleep as an eighth metric of cardiovascular health would improve cardiovascular disease risk prediction. A secondary objective of this work was to determine what aspects of sleep should be considered in cardiovascular risk assessment, given that sleep, much like diet, is a multidimensional health behavior.”
At baseline, there were 95 prior CV events, and during a mean follow-up of 4.4 years, there were 93 incident CV events, according to the researchers.
Among the cohort, 63% slept less than 7 hours per day, 10% had sleep efficiency less than 85%, 14% reported excess daytime sleepiness, 36% reported insomnia, 47% had obstructive sleep apnea, 39% had high night-to-night variability in sleep duration and 25% had high night-to-night variability in sleep-onset timing.
The Life’s Simple 7 score was not associated with CVD prevalence (HR for highest vs. lowest tertile = 0.69; 95% CI, 0.41-1.17) or CVD incidence (HR for highest vs. lowest tertile = 0.63; 95% CI, 0.38-1.05), Makarem and colleagues found.
However, the score based on Life’s Simple 7 and sleep duration was associated with CVD prevalence (HR for highest vs. lowest tertile = 0.39; 95% CI, 0.22-0.69), as was the score based on Life’s Simple 7 and sleep characteristics linked in the literature to CVD (HR for highest vs. lowest tertile = 0.41; 95% CI, 0.23-0.73), whereas the first score including Life’s Simple 7 and sleep characteristics linked in the MESA cohort to CVD was associated with CVD prevalence (HR for highest vs. lowest tertile = 0.45; 95% CI, 0.26-0.8) and incidence (HR for highest vs. lowest tertile = 0.56; 95% CI, 0.33-0.96), and the second such score was associated with CVD incidence (HR for highest vs. lowest tertile = 0.58; 95% CI, 0.34-0.96), according to the researchers.
“Notably, CV health scores that incorporate measures of sleep duration and quality as well as sleep disorders demonstrated the strongest associations with CVD prevalence and incidence,” Makarem told Healio. “These findings underscore the importance of embracing a holistic vision of sleep health that includes both sleep behaviors and sleep disorders when assessing cardiovascular risk. The approach to promoting a healthy lifestyle, which traditionally focused on diet and physical activity, should be expanded to encompass behaviors across the 24-hour period, including sleep. Health care providers should assess their patients’ sleep patterns, discuss sleep-related problems and educate patients about the importance of prioritizing sleep to promote CV health.”
Sleep and body composition
For the study on weight change, Marie-Pierre St-Onge, PhD, FAHA, CCSH, associate professor of nutritional medicine, director of the Sleep Center of Excellence and center director of the Go Red for Women Strategically Focused Research Network at Columbia University Irving Medical Center, and colleagues analyzed whether body composition was affected by changes in bedtime variability.
“When examining our data, I noticed that weight tended to decrease when women were undergoing habitual sleep (maintaining adequate sleep for 6 weeks) while weight tended to increase when they reduced their sleep,” St-Onge told Healio. “We expected the latter but not the former. So I started thinking about why that might be so and noted that our control condition (maintain habitual sleep) was asking women to be on their ‘best behavior’ for 6 weeks — go to bed and wake up at the same time each night to get adequate sleep every night. I posited that perhaps this stability in bedtime behaviors could be helpful for health. This led us to formally test this hypothesis.”
The study included 37 women (mean age, 35 years) who routinely slept 7 to 9 hours per night.
All women were assessed for change in bedtime variability, defined as the difference in the standard deviation of bedtimes measured during the 2-week screening period and the 6-week study phase.
Average percent change in bedtime variability was 24.4% in the eight women who increased or did not change their bedtime variability and –39.9% in the 29 women who reduced their bedtime variability during the study period, according to the researchers.
Compared with those who did not, women who reduced their bedtime variability reduced their total adipose tissue (–0.52 L vs. 0.63 L; P < .001) and their subcutaneous adipose tissue (–0.48 L vs. 0.56 L; P < .001), St-Onge and colleagues found.
“Maintaining stable bedtimes may have health benefits, including improvements in weight management,” St-Onge told Healio. “The improvements that we observed occurred without any recommendations related to diet, exercise or other weight-controlling behaviors. Clinicians should ask their patients about their sleep habits. They should not only ask about usual sleep duration, but also about the variability in patterns of sleep — duration, bedtime, wake time.” – by Erik Swain
References:
Makarem N, et al. Abstract 36.
St-Onge MP, et al. Abstract MP19. Both presented at: American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions; March 3-6, 2020; Phoenix.
Disclosures: Makarem reports no relevant financial disclosures. St-Onge reports she has financial ties with Jazz Pharma.
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Makarem N, et al. Abstract 36.
St-Onge MP, et al. Abstract MP19. Both presented at: American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions; March 3-6, 2020; Phoenix.
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