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Background Poor sleep increases cardiovascular disease risk, and diet likely contributes to this relationship. However, there are limited epidemiological data on the relationship between measures of sleep quality and habitual dietary patterns. This study examined these associations in a diverse sample of women. Methods and Results Baseline data from 495 participants in the AHA Go Red for Women prospective cohort study (age: 20–76 years; 61% racial/ethnic minority) were examined. Sleep quality and sleep‐onset latency were measured using the Pittsburgh Sleep Quality Index ( PSQI ) and insomnia using the Insomnia Severity Index. The validated Block Brief Food Frequency Questionnaire was used to assess diet quantity and quality. Linear regression models adjusted for confounding variables tested relationships between sleep and diet variables. Results showed that higher PSQI scores, indicative of poorer sleep quality, were associated with lower unsaturated fat intake (β=−0.14, P <0.05) and higher food weight (β=14.9, P =0.02) and added sugars consumed (β=0.44, P =0.04). Women with sleep‐onset latency >60 minutes had higher intakes of food by weight (β=235.2, P< 0.01) and energy (β=426, P <0.01), and lower intakes of whole grains (β=−0.37, P =0.01) than women with sleep‐onset latency ≤15 minutes. Greater insomnia severity was associated with higher food weight (β=9.4, P =0.02) and energy (β=17, P =0.01) consumed and lower total (β=−0.15, P =0.01) and unsaturated fat intakes (β=−0.11, P <0.01). Conclusions Poor sleep quality was associated with greater food intake and lower‐quality diet, which can increase cardiovascular disease risk. Future studies should test whether promoting sleep quality could augment efforts to improve cardiometabolic health in women.

Two factors intrinsic to health are diet and sleep. These two behaviors may well influence one another. Indeed, that insufficient sleep adversely impacts dietary intakes is well documented. On the other hand, diet may influence sleep via melatonin and its biosynthesis from tryptophan. Experimental data exist indicating that provision of specific foods rich in tryptophan or melatonin can improve sleep quality. Whole diets rich in fruits, vegetables, legumes, and other sources of dietary tryptophan and melatonin have been shown to predict favorable sleep outcomes. Although clinical trials are needed to confirm a causal impact of dietary patterns on sleep and elucidate underlying mechanisms, available data illustrate a cyclical relation between these lifestyle factors. We recommend adopting a healthful diet to improve sleep, which may further promote sustained favorable dietary practices. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Purpose of review: This review investigates the potential bi-directional relation between sleep and diet in considering their contribution to cardiovascular health. We further explore the involvement of the gut microbiome in the relationships between poor sleep and dietary intakes and increased cardiovascular disease (CVD) risk. Recent findings: There is strong evidence that sleep restriction leads to unhealthy food choices and increased energy intake. The diet may impact sleep, as well. Epidemiological studies show that higher adherence to a Mediterranean dietary pattern predicts healthier sleep. One factor that could underlie these relationships is the gut microbiome. Although data are mixed, there is some evidence that sleep restriction can influence the composition of the gut microbiome in humans. Similarly, Mediterranean diets and other plant-rich diets are related to increased diversity of the microbiota. At present, few studies have investigated the influence of the microbiome on sleep; however, limited evidence from epidemiological and intervention studies suggest that the composition of the microbiome may relate to sleep quality. More research is needed to better understand the role of the microbiome in the multi-directional relationship between sleep, diet and CVD. Summary: There is growing evidence of a bi-directional relationship between sleep and the diet, which could act in concert to influence CVD risk. Diets such as the Mediterranean diet, comprised of high intakes of fruits, vegetables, and other plant-based foods, may promote healthy sleep and beneficial gut microflora. The gut microbiome may then underlie the relation between diet, sleep, and CVD risk.