Abstract
Background and Objective
Sleep is an emerging risk factor for cardiovascular disease (CVD) that is not currently
included as a cardiovascular health (CVH) metric in the American Heart Association’s
Life’s Simple 7 (AHA LS7). Our objective was to evaluate the association of sleep
with CVH in women and examine differences by menopausal status and race/ethnicity.
Methods
Baseline data from the Columbia University AHA Go Red for Women Strategically Focused
Research Network were examined. Sleep habits were self-reported using validated questionnaires.
A CVH score was computed using AHA LS7 criteria for smoking, diet, physical activity,
BMI, blood pressure(BP), total cholesterol, and fasting glucose. Women received a
score of 2 (ideal), 1 (intermediate), or 0 (poor) based on their level of meeting
each AHA LS7 metric. Multivariable-adjusted regression models were used to evaluate
associations of sleep with meeting overall and individual CVH metrics.
Results
The analytical sample consisted of n = 507 women (62% minority/Hispanic, mean age:37
y). Participants with adequate sleep duration (≥7 h), good sleep quality, no insomnia
nor snoring, and low risk for OSA were more likely to meet >4 of the AHA LS7 metrics
(P < .01). Poorer sleep quality (β = −0.08, P = .002), higher insomnia severity (β = −0.05, P = .002), snoring (β = −0.77, P = .0001), and higher risk for OSA (β = −1.63, P < .0001) were associated with poorer CVH. Insomnia, snoring, and high OSA risk were
associated with 69% to >300% higher odds of having poor CVH (P ≤ .03). Associations were stronger in post-menopausal and racial/ethnic minority
women.
Conclusions
Better sleep habits were associated with more favorable CVH among women, suggesting
that there may be benefit in incorporating sleep assessment into CVD risk screening.
Keywords
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References
- Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond.Circulation. 2010; 121: 586-613
Folsom AR, Shah AM, Lutsey PL, et al. American Heart Association’s life’s simple 7: Avoiding heart failure and preserving cardiac structure and function. Am J Med. 2015;128(9):970–976. e2.
Ogunmoroti O, Oni E, Michos ED, et al. Life’s simple 7 and incident heart failure: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017;6(6):https://doi.org/10.1161/JAHA.116.005180.
- Life’s simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study.Stroke. 2013; 44: 1909-1914
- Cardiovascular health and protection against CVD: more than the sum of the parts?.Circulation. 2014; 130: 1671-1673
- Spatz ES, et al.A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations. 2016; 91: 649-670
Ogunmoroti O, Allen NB, Cushman M, et al. Association between life’s simple 7 and noncardiovascular disease: The multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2016;5(10):https://doi.org/10.1161/JAHA.116.003954.
- Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association.Circulation. 2016; 134: e367-e386
- Gender differences in associations between insufficient sleep and cardiovascular disease risk factors and endpoints: a contemporary review.Gender and the Genome. 2017; 1: 80-88
Jehan S, Masters-Isarilov A, Salifu I, et al. Sleep disorders in postmenopausal women. Journal of sleep disorders & therapy. 2015;4(5).
National Sleep Foundation. Sleep in America report. 2007. Washington, DC
- Sleep duration and cardiovascular disease: results from the national health interview survey.Sleep. 2010; 33: 1037-1042
- Trends in insomnia and excessive daytime sleepiness among US adults from 2002 to 2012.Sleep Med. 2015; 16: 372-378
- The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research.Psychiatry Res. 1989; 28: 193-213
- Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome.Ann Intern Med. 1999; 131: 485-491
- The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response.Sleep. 2011; 34: 601-608
- Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association council on high blood pressure research.Hypertension. 2005; 45: 142-161
Booth ML, Ainsworth BE, Pratt M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;195(9131/03):3508–1381.
- Reliability and validity of the international physical activity questionnaire (IPAQ).Med Sci Sports Exerc. 2004; 36: 556
Nutritionquest. development and validation of block FFQs and screeners. Website: http://www.nutritionquest.com/company/our-research-questionnaires/.
- The American Heart Association life’s simple 7 and incident cognitive impairment: the REasons for geographic and racial differences in stroke (REGARDS) study.J Am Heart Assoc. 2014; 3e000635
- Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA.Atherosclerosis. 2011; 219: 963-968
- Association of sleep characteristics with atrial fibrillation: the multi-ethnic study of atherosclerosis.Thorax. 2015; 70: 873-879
- Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the women’s health initiative.J Women Health. 2013; 22: 477-486
- The association of sleep duration and quality with all-cause and cause-specific mortality in the women’s health initiative.Sleep Med. 2018; 50: 48-54
- Meta-analysis of short sleep duration and obesity in children and adults.Sleep. 2008; 31: 619
- Association between short sleep duration and high incidence of metabolic syndrome in midlife women.Tohoku J Exp Med. 2011; 225: 187-193
- Self-reported sleep duration is associated with the metabolic syndrome in midlife adults.Sleep. 2008; 31: 635
- Short sleep duration as a risk factor for the development of the metabolic syndrome in adults.Prev Med. 2013; 57: 872-877
- The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of prospective cohort studies.Hypertens Res. 2013; 36: 985-995
- Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis.Diabetes Care. 2010; 33: 414-420
- Obstructive sleep apnea as a risk factor for type 2 diabetes.Am J Med. 2009; 122: 1122-1127
- Association of sleep characteristics with cardiovascular and metabolic risk factors in a population sample: the Chicago area sleep study.Sleep Health. 2017; 3: 107-112
- Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals.Am J Clin Nutr. 2011; 94: 410-416
- Eating behavior by sleep duration in the Hispanic community health study/study of Latinos.Appetite. 2015; 95: 275-284
- Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran.Nutrition. 2012; 28: 1146-1150
- Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women.Sleep Med. 2010; 11: 180-184
- Short-term sleep loss decreases physical activity under free-living conditions but does not increase food intake under time-deprived laboratory conditions in healthy men.Am J Clin Nutr. 2009; 90: 1476-1482
- Sleep duration as a correlate of smoking, alcohol use, leisure-time physical inactivity, and obesity among adults: United States, 2004-2006.Book Sleep duration as a correlate of smoking, alcohol use, leisure-time physical inactivity, and obesity among adults: United States. 2004-2006; 2008
- Gender and the association of smoking with sleep quantity and quality in American adults.Women Health. 2014; 54: 1-14
Gibson M, Munafo MR, Taylor A, Treur JL. Evidence for genetic correlations and bidirectional, causal effects between smoking and sleep behaviors. bioRxiv. 2018:258384.
- Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women.Sleep. 2008; 31: 979-990
- Association between sleep and blood pressure in midlife: the CARDIA sleep study.Arch Intern Med. 2009; 169: 1055-1061
- Short and long sleep duration associated with race/ethnicity, socio-demographics, and socioeconomic position.Sleep. 2014; 37: 601-611
Zhang Z, Gillespie C, Merritt R, Yang Q. Association Between Cardiovascular Health and Depression Among US Adults: NHANES 2007–2014. Circulation. 2017;136(suppl_1):A14562.
- Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999–2006.Int J Cardiol. 2015; 191: 296-300
Article info
Publication history
Published online: July 10, 2019
Accepted:
May 29,
2019
Received in revised form:
May 17,
2019
Received:
March 15,
2019
Identification
Copyright
© 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
