Rest Assured
Sleep is a critical physiological process that allows the body to rest, repair, and rejuvenate. Along with diet and physical activity, sleep is one of the most important pillars of health. Sleep not only impacts mental clarity and productivity; it profoundly influences cardiovascular health.
Both optimal and poor sleep patterns have significant effects on the heart and vascular system, shaping the risk profile for various cardiovascular issues.
In fact, the American Heart Association highlighted this association with a Scientific Statement in September 2016, and subsequently added sleep to its “Life's Essential 8” checklist for heart health in February 2023.
By taking this step, the AHA emphasized the role of sleep on maintaining healthy blood pressure, cholesterol levels, and body weight, all of which are critical for heart health.
Unfortunately, poor sleep is very prevalent in the general population.
Approximately 1 in 3 US adults are short sleepers (getting on average <7 hrs of sleep per day), and fewer than half US adults report having a good night of sleep every night.
The Role of Optimal Sleep in Cardiovascular Health
Optimal sleep duration appears to be 7-9 hours per night for adults, based on numerous studies, including a 2017 meta-analysis of 43 studies that indicated that both short sleep (<7 h/night) and long sleep (>8 h/night) were associated with a greater risk of all-cause mortality.
Studies have consistently shown that individuals who achieve optimal sleep duration are less likely to develop cardiovascular diseases and have reduced risk of major cardiovascular events.
During deep sleep, heart rate and blood pressure decline, allowing the cardiovascular system to rest and recover.
This "nocturnal dipping" is crucial for maintaining vascular health and reducing the risk of hypertension.
Moreover, this duration of sleep has been shown to enhance glucose metabolism and improve regulation of hormones such as cortisol and melatonin, which impact heart health.
The Impact of Poor Sleep on the Cardiovascular System
In contrast, poor sleep—characterized by insufficient duration, fragmented patterns, or conditions like insomnia and sleep apnea—can have significant detrimental effects on the cardiovascular system.
A 2011 systematic review found that short sleep duration was associated with a 45% increased risk of coronary heart disease.
And it’s not just sleep duration that matters.
Quality of sleep is also linked to CV outcomes.
One study examined the association of insomnia symptoms with heart disease and stroke:
People with non-restful sleep had a 16% higher risk of heart disease and stroke, people with difficulty initiating sleep had a 22% higher risk, and people with difficulty maintaining sleep had a 14% higher risk.
In fact, having any insomnia complaint was associated with 13% higher risk.
A more recent study showed that difficulty falling asleep > 2 times/week, and trouble staying asleep > 2 times/week were related to worse CV outcomes.
These researchers reported that life expectancy at age 30 years for individuals with optimal sleep was 4.7 years greater for men and 2.4 years greater for women, when compared to those with low-quality sleep.
How does poor sleep exert this effect on CV health?
There are many different pathways by which chronically poor sleep can be detrimental to CV health.
Chronic sleep deprivation leads to increased sympathetic nervous system activity, elevated stress hormone levels, and systemic inflammation.
Additionally, poor sleep exacerbates the metabolic syndrome—a cluster of conditions including high blood pressure, elevated blood sugar, and abnormal cholesterol levels—which is a significant risk factor for heart disease and stroke.
And of course Obstructive Sleep Apnea (OSA) is particularly harmful.
OSA is a condition characterized by episodes of slow breathing or no breathing throughout the night. It is veryt common in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, and atrial fibrillation.
OSA is strongly associated with increased risks of stroke and heart failure.
Sleep is a cornerstone of cardiovascular health, and research reveals that its effects are similar to those of diet and physical activity.
While optimal sleep protects the heart and vascular system, poor sleep increases the risk of developing hypertension, plaque and other cardiovascular conditions.
Clinicians and patients alike should recognize the profound impact of sleep on cardiovascular health and take proactive measures to ensure restorative, rejuvenating sleep.
By being aware of the role of sleep quality, we can reduce the burden of cardiovascular disease, and improve not just lifespan, but healthspan.
Wisconsin Cardiology Associates Recommends:
- Prioritize Sleep: Aim for 7-9 hours of quality sleep each night to support overall health and reduce cardiovascular risks.
- Practice Good Sleep Hygiene: Create a routine that includes a consistent bedtime, a dark and quiet sleeping environment, and make sure to avoid screens/technology before (or in) bed.
- Recognize Symptoms: Be aware of signs of sleep disorders, such as snoring, daytime fatigue, and difficulty staying asleep, and discuss these symptoms with your provider team.
- Limit Stimulants: Avoid caffeine and alcohol intake, especially in the hours leading up to bedtime, as they can disrupt sleep.
- Manage Stress: Incorporate relaxation techniques such as meditation, mindfulness or deep breathing to promote restful sleep and reduce stress levels.
References:
American Heart Association (2021). Circulation.
Cappuccio, F. P., et al. (2011). JACC, 57(9), 99-107.
Ahmad, A., & Didia, C. (2020). Current Cardiology Reports, 22, 1-5.
Yin, J et al. J Am Heart Assoc. 2017 Sep 9;6(9):e005947
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