Short sleep duration, snoring linked to risk for incident heart failure
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In a prospective study of more than 90,000 participants, short sleep duration and snoring were associated with elevated risk for incident HF.
The researchers conducted a prospective study of 93,613 Chinese adults from the Kailuan cohort who were free from preexisting CVD to investigate whether self-reported short sleep duration and snoring, the latter of which served as a surrogate for obstructive sleep apnea (OSA), were associated with incident HF during a median follow-up of 8.8 years.
Data were derived from Zhuang S, et al. Heart. 2023;doi:10.1136/heartjnl-2022-321799.
During the study period, 1,343 participants developed HF, Sheng Zhuang, MD, from the department of neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China, and colleagues wrote.
After adjustment for confounders such as age, sex, smoking, hypertension and diabetes, compared with sleep duration of 7 to 7.9 hours per night, sleep duration shorter than 6 hours per night was associated with elevated risk for incident HF (HR = 1.24; 95% CI, 1.01-1.55), as was sleep duration of 6 to 6.9 hours per night (HR = 1.29; 95% CI, 1.06-1.57), the researchers wrote.
In addition, compared with people who reported never or rarely snoring, those who reported occasional snoring had elevated risk for incident HF (HR = 1.32; 95% CI, 1.14-1.52), as did those who reported frequent snoring (HR = 1.24; 95% CI, 1.06-1.46), according to the researchers.
Diabetes mediated the association between incident HF, short sleep duration and snoring, whereas hypertension mediated the association between incident HF and snoring, Zhuang and colleagues wrote, noting there was no mediation effect from MI.
“Sleep restriction could increase sympathetic activity and further lead to hypertension and coronary artery disease, two important determinants of HF,” the researchers wrote. “However, in [the] current analysis, the short sleep duration-HF relationship was significantly mediated only by diabetes, indicating that the influence of sleep deprivation on HF may be more preferentially through blood glucose abnormality.”
In addition, they wrote: “The underlying mechanisms on snoring and HF risk might largely be explained by the role of OSA. It is well known that frequent arousal in OSA patients could increase sympathetic overactivity, thus causing elevation in BP and heart rate and activation of the renin-angiotensin-aldosterone system. This may further promote hypertension by accelerating the progression of HF due to sodium and fluid retention. .... Sleep fragmentation and hypoxemia in OSA can also alter glucose metabolism and promote insulin resistance. In [the] current analysis, we found that both hypertension and diabetes mediated the association between snoring and HF, which, to some extent, was in accordance with these proposed mechanisms.”
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