Objective Sleep Duration Is Prospectively Associated With Endothelial Health

Hall, Martica; Mulukutla, Suresh; Kline, Christopher E.; Samuelsson, Laura B.; Taylor, Briana J.; Thayer, Julian F.; Krafty, Robert T.; Frank, Ellen; Kupfer, David J.

doi:10.1093/sleep/zsw003

Cited by 21 publications

(12 citation statements)

References 51 publications

(75 reference statements)

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“…According to PSG measurements, patients in the study group had decreased sleep duration (total sleep time) and slow wave sleep (SWS), increased wake time after sleep onset and sleep fragmentation. Short sleep duration and sleep fragmentation are related to sympathetic excitation, 25 high blood pressure, 26 vascular endothelial inflammation 27 and endothelial injury, 28 while decrease in SWS could lead to abnormal immune regulation in view of its importance in adaptive immune memory. 29 Based on these results, it is reasonable to assume that changes in sleep characteristics of CSVD patients contribute to the abnormal inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Wang

Chen

Men

et al. 2020

NSS

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Objective: Chronic inflammatory responses and leukocyte infiltration are classical pathological features of cerebral small vessel disease (CSVD). To date, limited evidence of a relationship between chronic insomnia and inflammatory responses in patients with CSVD has been uncovered. The purpose of the present study was to investigate the potential relationship between chronic insomnia and pro-inflammatory cytokine levels in patients with atherosclerotic CSVD (A-CSVD). Methods: In total, 76 A-CSVD patients with or without chronic insomnia (CI) confirmed using magnetic resonance (MR) were prospectively recruited. Overnight polysomnography (PSG) was performed and serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-17A, IL-8, and IL-12 assessed. Cytokine levels were compared between CSVD+CI (study group) and CSVD without CI (control group) patients, and the correlations between PSG parameters and cytokine levels were explored in all patients via multiple linear regression analyses. Results: The serum IL-8 level of the study group (12.3±4.4 pg/mL) was significantly higher than that of the control group (7.5±2.2 pg/mL; P<0.05). PSG measurements showed that patients in the study group had significantly higher sleep onset latency (SOL), arousal index (ArI) and wake after sleep onset (WASO) as well as lower total sleep time (TST), sleep efficiency (SE) and stage 3 NREM sleep (N-3) ratio, compared with the control group (P<0.05). Multiple linear regression analyses led to the identification of ArI (β=0.026, P<0.05) and TST (β=−0.054, P<0.05) as significant positive and negative predictors of the IL-8 level, respectively. Conclusion: Chronic insomnia, in particular, sleep fragmentation and short sleep duration, may be involved in promotion of serum IL-8 expression in patients with atherosclerotic CSVD.

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Section: Discussionmentioning

confidence: 99%

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Wang

Chen

Men

et al. 2020

NSS

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“…20,21 Short sleep duration has been associated with cardiometabolic syndrome 22 and sub-clinical cardiovascular disease denoted by coronary calcification, 23 carotid intimal thickening, 24 and endothelial dysfunction. 25 Potential mechanisms for long sleep duration include sleep fragmentation, fatigue, lack of physiological challenge, depression, low socioeconomic status, obstructive sleep apnea, cancer, and respiratory disase. 18,21,26,27 Finally, higher cardiovascular mortality with long sleep duration may be mediated through other cardiovascular risk factors, as adjustment for these attenuated the association between long sleep duration and cardiovascular mortality in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Sleep Duration and Mortality in Patients With Coronary Artery Disease

Kim

Hayek

et al. 2019

The American Journal of Cardiology

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Extremes in sleep duration are associated with higher cardiovascular risk in the general population, but their impact in patients with documented coronary artery disease (CAD) remains unknown and potentially of clinical significance. We hypothesized that both short and long sleep duration are associated with higher mortality in CAD. We inquired about sleep durations in 2,846 patients enrolled in the Emory Cardiovascular Biobank (mean age 64 years, 38% female, 23% Black, and 82% with obstructive CAD, defined by positive coronary angiography), who were then followed for all-cause and cardiovascular mortality. Multivariate Cox proportional hazard models were calculated to examine the association of sleep duration and mortality. Sleep durations of <6.5 hours (short), ≥6.5 to <7.5 hours (normal), and ≥ 7.5 hours (long), were reported by 39%, 26% and 35% of the cohort, respectively. On follow-up (median 2.8 years), mortality rates were 15%, 11%, and 17%, respectively. After adjusting for demographics and risk factors, both short and long sleep duration were associated with higher all-cause mortality (HR 1.44, 95% CI [1.10-1.89] and 1.41 [1.08-1.85], respectively). A similar pattern was demonstrated for cardiovascular mortality only for short (HR 1.48 [1.05-2.09]), but not long sleep duration. In conclusion, in patients with frank CAD, both short and long sleep duration were independently associated with higher all-cause mortality, and short sleep was independently associated with higher cardiovascular mortality. In conclusion, our study is the first to extend the observations of sleep duration and mortality from population-based studies to patients with documented cardiac disease.

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“…The mechanisms underlying the association between sleep duration and hypertension remains unclear although several hypotheses have been proposed. Short sleep duration may increase BP through enhanced sympathetic activity, activation of inflammatory responses, endothelial dysfunction, insulin resistance, and/or blunted nocturnal BP decreases 34–37 . Moreover, oxidative stress may be implicated.…”

Section: Discussionmentioning

confidence: 99%

Objective but Not Subjective Short Sleep Duration Is Associated With Hypertension in Obstructive Sleep Apnea

et al. 2018

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Extremes of sleep duration and obstructive sleep apnea (OSA) are both associated with hypertension. We aimed to explore whether sleep duration modifies the relationship between OSA and prevalent hypertension, using both objective and subjective measures of total sleep duration. A total of 7107 OSA patients and 1118 primary snorers were included in the study. Hypertension was defined based either on direct blood pressure measures or on diagnosis by a physician. Objective sleep duration was derived by polysomnography and subjective sleep duration was self-reported. Logistic regression models were used to estimate the associations between objective/subjective sleep duration and hypertension prevalence in OSA and primary snorers. Compared with primary snorers, OSA combined with objective sleep duration of 5 to 6 hours increased the odds of hypertension by 45% (odds ratio, 1.45; 95% confidence interval, 1.14-1.84), whereas OSA combined with objective sleep duration <5 hours further increased the odds of hypertension by 80% (odds ratio, 1.80; 95% confidence interval, 1.33-2.42). These results were independent of major confounding factors frequently associated with OSA or hypertension. In stratified analysis by sleep duration, risk of hypertension in those with extremely short sleep (<5 hours) was not significantly different between OSA and primary snorers, whereas odds were significant for OSA in the other 4 sleep duration strata (5-6, 6-7, 7-8, and >8 hours). No significance was evident using subjective sleep duration. We conclude that objective short sleep duration is associated with hypertension in OSA patients. Extremely short sleep duration in itself may actually be even more detrimental than OSA in terms of hypertension risk.

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Objective Sleep Duration Is Prospectively Associated With Endothelial Health

Abstract: Objectively assessed short sleep duration was prospectively associated with increased BAD over a 12- to 30-year period.

Cited by 21 publications

References 51 publications

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Sleep Duration and Mortality in Patients With Coronary Artery Disease

Objective but Not Subjective Short Sleep Duration Is Associated With Hypertension in Obstructive Sleep Apnea

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