Insomnia and Endothelial Function – The HUNT 3 Fitness Study

Strand, Linn Beate; Laugsand, Lars Erik; Skaug, Eli-Anne; Ellingsen, Øyvind; Madssen, Erik; Wisløff, Ulrik; Vatten, Lars J.; Janszky, Imre

doi:10.1371/journal.pone.0050933

Cited by 10 publications

(12 citation statements)

References 41 publications

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“…However, the effects of perceived sleep quality and insomnia in the absence of sleep deprivation on endothelial function are less clear. The lack of association between sleep quality and insomnia score, and brachial artery FMD in our study in a subset of women who slept more than 7 hours/night is in accordance with previous reports where FMD has been mostly unaffected by sleep quality in the absence of curtailed sleep duration 37, 38, 39, 40. We tested mRNA expression of pro‐inflammatory genes ICAM‐1 and VCAM‐1 , which are considered essential for transendothelial migration of monocytes into the arterial wall; however, no significant correlation with perceived sleep quality or ISI score was observed.…”

Section: Discussionsupporting

confidence: 93%

Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Aggarwal

Makarem

Shah

et al. 2018

JAHA

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BackgroundInsufficient sleep increases blood pressure. However, the effects of milder, highly prevalent but frequently neglected sleep disturbances, including poor sleep quality and insomnia, on vascular health in women are unclear. We investigated whether poor sleep patterns are associated with blood pressure and endothelial inflammation in a diverse sample of women.Methods and ResultsWomen who participated in the ongoing American Heart Association Go Red for Women Strategically Focused Research Network were studied (n=323, 57% minority, mean age=39±17 years, range=20–79 years). Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index (score ≥5=poor sleep quality). Risk for obstructive sleep apnea was evaluated using the Berlin questionnaire, and insomnia was assessed using the Insomnia Severity Index. In a subset of women who participated in the basic study (n=26), sleep duration was assessed objectively using actigraphy, and endothelial inflammation was assessed directly in harvested endothelial cells by measuring nuclear translocation of nuclear factor kappa B. Vascular reactivity was measured by brachial artery flow‐mediated dilation (n=26). Systolic and diastolic blood pressure were measured by trained personnel (n=323). Multivariable linear regressions were used to evaluate associations between sleep patterns and blood pressure, nuclear factor kappa B, and flow‐mediated dilation. Mean sleep duration was 6.8±1.3 hours/night in the population study and 7.5±1.1 hour/night in the basic study. In the population study sample, 50% had poor sleep quality versus 23% in the basic study, and 37% had some level of insomnia versus 15% in the basic study. Systolic blood pressure was associated directly with poor sleep quality, and diastolic blood pressure was of borderline significance with obstructive sleep apnea risk after adjusting for confounders (P=0.04 and P=0.08, respectively). Poor sleep quality was associated with endothelial nuclear factor kappa B activation (β=30.6; P=0.03). Insomnia and longer sleep onset latency were also associated with endothelial nuclear factor kappa B activation (β=27.6; P=0.002 and β=8.26; P=0.02, respectively). No evidence was found for an association between sleep and flow‐mediated dilation.ConclusionsThese findings provide direct evidence that common but frequently neglected sleep disturbances such as poor sleep quality and insomnia are associated with increased blood pressure and vascular inflammation even in the absence of inadequate sleep duration in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02835261.

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Section: Discussionsupporting

confidence: 93%

Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Aggarwal

Makarem

Shah

et al. 2018

JAHA

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“…12 This study extends findings by reporting an association between insomnia symptoms and FMD in people with relatively low cardiovascular risk factor burden (FRS 6.1%±5.7). …”

Section: Discussionsupporting

confidence: 80%

“…11 Less is known about the relationship between insomnia symptoms and endothelial function with only one study of healthy adults finding lower FMD in women, but not men, reporting frequent early morning awakenings. 12 Endothelial dysfunction may be a mechanism by which insomnia affects CV health. The aim of this cross-sectional, secondary analysis of the Emory-Georgia Tech Predictive Health Initiative cohort study was to compare endothelial function in a community sample of working adults (n=496) with and without symptoms of insomnia.…”

Section: Introductionmentioning

confidence: 99%

Insomnia Symptoms Are Associated With Abnormal Endothelial Function

Routledge¹,

Dunbar

Higgins³

et al. 2017

J Cardiovasc Nurs

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Background Insomnia is a prevalent sleep disorder and it has been increasingly associated with cardiovascular morbidity and mortality. The reasons for this relationship are not completely understood but may involve endothelial dysfunction. In this study, we hypothesized that insomnia symptoms would be associated with reduced endothelial function. Methods Working adults [n=496, 67.5% female, 78.6% white, mean age: 48.7±10.8 years, body mass index (BMI): 28.2±6.7 kg/m2, diabetes: 5.8%, hypertension: 20.0%, hyperlipidemia: 17.9%, heart disease: 2.6%] enrolled in the Emory-Georgia Tech Predictive Health Institute study completed baseline demographic, clinical, depression (Beck Depression Inventory II; BDI-II), anxiety (General Anxiety Disorder-7; GAD-7) sleep (Pittsburg Sleep Quality Index , PSQI) and non-invasive endothelial function (brachial artery flow-mediated dilation; FMD) measures. Insomnia symptoms were defined as subjective sleep latency of ≥ 30 minutes, nighttime or early morning awakenings and/or sleep medication use occurring ≥ 3 times per week in the past month. Results Insomnia symptoms were reported by 39.5% of participants. Multivariable regression models showed that insomnia symptoms, age, baseline artery diameter and dyslipidemia were inversely related to FMD. After adjusting for age, baseline artery diameter, and dyslipidemia participants reporting insomnia symptoms had lower FMD than participants reporting better sleep (adjusted FMD means= 6.13%±0.28 vs 6.83%±0.26, p=.035). Conclusion In this study insomnia symptoms were associated with reduced FMD. Research examining the therapeutic benefits of treating insomnia on endothelial function and future cardiovascular risk is warranted.

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“…For example, although laboratory-based studies of experimental sleep deprivation may increase adhesion molecules and E-selectin 8 or result in elevated blood pressures 9 , whether such relationships are also reflected in subjects’ verbal reports about their own short duration of sleep remain far more dubious. Low reported sleep quality in a large population based sample 10 was reported to be unrelated to altered FMD and short reported sleep durations were unrelated to levels of endothelial progenitor cells 11 , but other studies suggest that reported (or actigraphically assessed) short sleep durations may be associated with increased carotid intima-media thickness 12,13 or coronary artery calcification 14 . In this study, we examined self-reported, sleep-related symptoms in a community-based, non-clinic population with commonly used standardized scales and related these results to brachial artery FMD – long recognized to be the gold standard of abnormal endothelial dysfunction 15 .…”

Section: Introductionmentioning

confidence: 99%

Vascular Endothelial Function and Self-reported Sleep

Behl

Veledar

Quyyumi

et al. 2014

The American Journal of the Medical Sciences

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Background We investigated the relationship between self-reported sleep characteristics and brachial artery flow-mediated dilation (FMD) in a community-based population. Prior studies document that sleep apnea may be related to endothelial dysfunction but disagree whether subjective reports of sleep may also reflect such associations. Methods In 684 subjects (32% male) between 37 and 60 years enrolled in the Emory-Georgia Tech Predictive Health Institute study, we measured reported sleep characteristics using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) along with cardiovascular risk factors. Endothelial function was assessed using brachial artery FMD. Multivariate analysis of covariance was used to adjust for various cardiovascular risk factors including age, race, gender, smoking, hypertension, diabetes, and body mass index. Results Lower brachial artery FMD values were correlated with higher ESS scores (p = 0.0275), even after adjustment for risk factors (p = 0.03). Total PSQI score was unrelated to brachial artery FMD. However, lower sleep quality (PSQI component 1) was associated with lower brachial artery FMD (multivariate p = 0.038), and participants who coughed or snored during sleep also had lower brachial artery FMD (6.24±3.42%) compared to those who did not (6.92±4.30%) (p = 0.056). This difference remained significant after adjustment for risk factors (p = 0.03). Conclusion In a community-based population, our analysis indicates a significant association between sleepiness and snoring assessed by questionnaires and endothelial function. Simple subjective reports about individuals’ sleep may be highly revealing indicators of endothelial function impairment and thus important indicators of cardiovascular disease risk.

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Insomnia and Endothelial Function – The HUNT 3 Fitness Study

Cited by 10 publications

References 41 publications

Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Insomnia Symptoms Are Associated With Abnormal Endothelial Function

Vascular Endothelial Function and Self-reported Sleep

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