Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States for both men and women. The increasing appreciation of the gender differences in behavioral and physiologic interconnectedness of cardiometabolic risk factors has led to a growing literature evaluating relationships between sleep-an integral part of overall health and a source of physiological resilience-in relation to CVD and its risk factors in male and female cohorts. This article reviews the published research related to gender differences in the role of insufficient sleep in the etiology of CVD. Evidence on gender differences in the associations between sleep and other behavioral risk factors for CVD, namely diet and physical activity, is in the nascent stages of characterization but suggests that insufficient sleep may have a more pronounced detrimental impact on the diets of women. The literature on gender differences in the role of insufficient sleep in inflammation, dyslipidemia, glycemic control and insulin sensitivity, and obesity is inconclusive. Inadequate sleep duration is associated with elevated blood pressure, weight gain, hypertension, and obesity in both men and women, but associations may be stronger among women. Moreover, gender differences may vary by age group. Inflammation resulting from inadequate sleep may also be more pronounced among women. Inconsistent results were observed in studies on dyslipidemia with results ranging from null to detrimental associations in men and from detrimental to protective associations in women. Short sleep is also associated with poor glycemic control among men, with evidence of potential gender differences in associations with insulin sensitivity. Finally, insufficient sleep is convincingly associated with CVD etiology, but women appear to be more vulnerable to the effects of poor sleep on CVD risk and mortality. In conclusion, emerging data demonstrate that heterogeneity exists between men and women in how sleep duration influences behavioral and cardiometabolic risk factors in addition to CVD risk and mortality, but additional research is warranted to clarify associations and disentangle underlying mechanisms. In an era of genomics and personalized medicine, studying gender differences in the role of sleep in the risk for cardiometabolic disease is crucial for identifying innovative targets and tailoring public health interventions to focus on the most vulnerable population groups.
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