Background: Both short and long sleep duration, as well as poor quality of sleep have been associated with an increased risk of cardiovascular disease. However, big studies evaluating objectively measured sleep parameters and subclinical atherosclerosis assessed by multimodality imaging approach are still lacking.
Objectives: To evaluate the association of actigraphy-measured sleep parameters with subclinical atherosclerosis in a large asymptomatic middle-aged population included in the PESA (Progression of Early Subclinical Atherosclerosis) study. Moreover, to investigate possible interactions between sleep parameters and conventional risk factors, psychosocial characteristics, dietary habits, inflammatory and aging markers.
Methods: A total of 3974 PESA study participants (mean age 45.8±4.3; 62.6% men) underwent actigraphic recording during one week. Four groups were defined according to sleep duration: 1) and 2) Participants with short sleep duration (SSD) (below 6h and 6–7h); 3) Reference group with 7–8h of sleeping; 4) Participants with long sleep duration (above 8h). Additionally, the cohort was divided into five quintiles taking into account quality of sleep (Fragmentation Index (FI)). Medical history data, blood tests and dietary habits were included. 3D vascular ultrasound (VUS) and coronary computed tomography (CT) were performed to quantify noncoronary atherosclerosis and coronary calcification, respectively.
Results: Sleep duration below 6 h was independently associated with a higher atherosclerotic burden and more affected vascular territories measured with 3D VUS compared to reference group (OR: 1.19, CI 95%: 1.00–1.42; p=0.05 and OR: 1.23, CI 95%: 1.03–1.47; p=0.02, respectively). Participants with a more fragmented sleep (Quintile 5; FI: 7.39–43.43) also presented a higher risk towards more affected territories (adjusted OR: 1.35, CI 95%: 1.05–1.65; p=0.01). Coronary calcification was not independently associated with sleep parameters. No differences were observed regarding inflammation and aging biomarkers and sleep parameters. However, SSD-participants presented more frequently with metabolic syndrome (MetS).
Conclusions: Actigraphy measured SSD and fragmented sleep are associated with an increased risk of noncoronary atherosclerosis and a higher prevalence of MetS. These findings show that sleep is associated with cardiovascular health and suggest that the modification of abnormal sleep patterns may contribute to the reduction of the burden of cardiovascular diseases.