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J Am Coll Cardiol. 2019 Jan 22;73(2):134-144. doi: 10.1016/j.jacc.2018.10.060.

Association of Sleep Duration and Quality With Subclinical Atherosclerosis.

Author information

1
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
2
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: vfuster@cnic.es.
3
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
4
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain.
5
IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain.
6
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain; Cardiovascular Institute, IDSSC, Hospital Clínico San Carlos, Madrid, Spain.
7
Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Faculty of Health Sciences, University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Madrid, Spain.
8
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
9
Banco de Santander, Madrid, Spain.
10
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain.
11
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
12
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
13
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain; U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts. Electronic address: jose.ordovas@tufts.edu.

Abstract

BACKGROUND:

Sleep duration and quality have been associated with increased cardiovascular risk. However, large studies linking objectively measured sleep and subclinical atherosclerosis assessed in multiple vascular sites are lacking.

OBJECTIVES:

The purpose of this study was to evaluate the association of actigraphy-measured sleep parameters with subclinical atherosclerosis in an asymptomatic middle-aged population, and investigate interactions among sleep, conventional risk factors, psychosocial factors, dietary habits, and inflammation.

METHODS:

Seven-day actigraphic recording was performed in 3,974 participants (age 45.8 ± 4.3 years; 62.6% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study. Four groups were defined: very short sleep duration <6 h, short sleep duration 6 to 7 h, reference sleep duration 7 to 8 h, and long sleep duration >8 h. Sleep fragmentation index was defined as the sum of the movement index and fragmentation index. Carotid and femoral 3-dimensional vascular ultrasound and cardiac computed tomography were performed to quantify noncoronary atherosclerosis and coronary calcification.

RESULTS:

When adjusted for conventional risk factors, very short sleep duration was independently associated with a higher atherosclerotic burden with 3-dimensional vascular ultrasound compared to the reference group (odds ratio: 1.27; 95% confidence interval: 1.06 to 1.52; p = 0.008). Participants within the highest quintile of sleep fragmentation presented a higher prevalence of multiple affected noncoronary territories (odds ratio: 1.34; 95% confidence interval: 1.09 to 1.64; p = 0.006). No differences were observed regarding coronary artery calcification score in the different sleep groups.

CONCLUSIONS:

Lower sleeping times and fragmented sleep are independently associated with an increased risk of subclinical multiterritory atherosclerosis. These results highlight the importance of healthy sleep habits for the prevention of cardiovascular disease.

KEYWORDS:

3D vascular ultrasound; actigraph; cardiac computed tomography; sleep; subclinical atherosclerosis

PMID:
30654884
DOI:
10.1016/j.jacc.2018.10.060

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