Association between sleep duration and sleep quality with arterial stiffness: A systematic review and meta-analysis

Association between sleep duration and cardiovascular risk: the EVasCu cross-sectional study

Introduction

Some cardiovascular risk markers have been associated with alterations in sleep duration in different populations; however, there is little evidence in a healthy population.

Aim

The aim of the present study was to analyze the associations between sleep duration and cardiovascular risk biomarkers, including advanced glycation end-products (AGEs) measured by skin autofluorescence (SAF), maximum carotid intima-media thickness (IMTMax), aortic pulse wave velocity (a-PWV), pulse pressure (PP), and low-density lipoprotein cholesterol (LDL-C), in healthy adults (EVasCu study).

Methodology

The EVasCu study included 390 participants. Simple and multiple linear regressions were performed between sleep duration and cardiovascular risk markers. ANOVA analysis and ANCOVA analysis adjusted for various covariates were then performed after categorizing sleep into 6 h, 6-8 h, and >8 h.

Results

296 participants were included in the analyses (43.97 ± 12.60 years, 63.9% female). Simple linear regressions showed an inverse association between sleep duration and SAF, IMTMax, aPWV and PP. However, in the multiple linear regression with all the covariates, the statistical significance was lost. For its part, in the ANOVA analyses, sleep duration was also associated with the same parameters, but when performing the fully adjusted ANCOVA analyses, the statistical significance for SAF was maintained (p = 0.015), obtaining a difference of 0.223 arbitrary units (p = 0.017) when comparing the group <6 h vs. > 8 h. Finally, there was no association for LDL-C.

Conclusion

An inverse association was found between sleep duration and APS, which is considered a marker of cardiovascular risk. Although prospective studies are needed, it is suggested that insufficient sleep may increase cardiovascular risk, which could be a key factor in future public health policies to promote health and prevent CVD.

Causal associations between sleep traits and temporomandibular disorders: a bidirectional mendelian randomization analysis

Objectives

This study aims to investigate the relationship between five sleep traits (insomnia, sleep duration, getting up in morning, snoring, and daytime nap) and temporomandibular disorders (TMD) using bi-directional Mendelian randomization.

Methods

The bi-directional Mendelian randomization study was conducted in two stages. Initially, sleep traits were examined as exposures while TMD was evaluated as an outcome, whereas the second step was reversed. The inverse variance weighted (IVW) method and other Mendelian randomization methods were used for analysis. Furthermore, we performed the MR-Egger intercept, MR-PRESSO, Cochran's Q test, and "Leave-one-out" to assess the levels of pleiotropy and heterogeneity.

Results

The IVW method indicates that getting up in the morning reduces the risk of developing TMD (OR = 0.50, 95% CI 0.30-0.81, p = 0.005), while insomnia may increase the risk of TMD (OR = 2.05, 95% CI 1.10-3.85, p = 0.025). However, other sleep traits are not associated with the risk of TMD, and having TMD does not alter an individual's sleep traits. After removing outliers, the results remained robust, with no pleiotropy detected.

Conclusion

Genetically determined difficulty in getting up in the morning and insomnia can increase the risk of TMD. By optimizing sleep, the risk of developing TMD can be reduced. This underscores the importance of sleep in preventing TMD.

Parent-child associations of sleep quality: is physical activity a confounder? The EPI-FAMILY health study

INTRODUCTION

The incidence of sleep deprivation has increased in pediatric populations, however, the relationship with physical activity (PA) remains uncertain and lacks evidence. Although some studies have shown that parents' lifestyle habits can influence this process, one point that requires further clarification in the literature is whether parents' sleep quality is linked to that of their children and whether parents' physical activity could play an important role in these possible relationships.

OBJECTIVES

To investigate the relationship of sleep quality between parents and children and verify the role of physical activity in this association.

METHODS

This is a cross-sectional study. Sleep quality was assessed using the Mini Sleep Questionnaire. The amount of sleep was estimated by the number of hours slept. PA domains (occupational activities, leisure, and active commuting) were assessed using the Baecke questionnaire, while moderate to vigorous PA (MVPA) was assessed with an accelerometer. Socioeconomic status was obtained through a questionnaire. The relationship of sleep quality between parents and children was carried out using hierarchical models with Binary Logistic Regression, where the factors were inserted one by one (1. unadjusted model; 2. sociodemographic variables; 3. children's PA; 4. parents' PA).

RESULTS

The study sample consisted of 102 children and adolescents (6-17 years), 92 mothers, and 69 fathers. Poor sleep quality of mothers was associated with their children's sleep quality (OR = 3.95; 95%CI = 1.33-11.38; P = 0.013). After inserting mothers' PA intensity into the final model, the associations remained significant (OR = 8.05; 1.33-48.59; P = 0.023). No relationship was observed between poor sleep quality of fathers and their children's sleep quality.

CONCLUSION

The relationship between poor sleep quality of mothers and that of their children remained significant, regardless of confounding variables.

Association of Cumulative Exposure to Cardiovascular Health Behaviors and Factors with the Onset and Progression of Arterial Stiffness

AIM

This study aims to explore the association of cumulative exposure to cardiovascular health behaviors and factors with the onset and progression of arterial stiffness.

METHODS

In this study, 24,110 participants were examined from the Kailuan cohort, of which 11,527 had undergone at least two brachial-ankle pulse wave velocity (baPWV) measurements. The cumulative exposure to cardiovascular health behaviors and factors (cumCVH) was calculated as the sum of the cumCVH scores between two consecutive physical examinations, multiplied by the time interval between the two. A logistic regression model was constructed to evaluate the association of cumCVH with arterial stiffness. Generalized linear regression models were used to analyze how cumCVH affects baPWV progression. Moreover, a Cox proportional hazards regression model was used to analyze the effect of cumCVH on the risk of arterial stiffness.

RESULTS

In this study, participants were divided into four groups, according to quartiles of cumCVH exposure levels, namely, quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Logistic regression analysis showed that compared with the Q1 group, the incidence of arterial stiffness in terms of cumCVH among Q2, Q3, and Q4 groups decreased by 16%, 30%, and 39%, respectively. The results of generalized linear regression showed that compared with the Q1 group, the incidence of arterial stiffness in the Q3 and Q4 groups increased by -25.54 and -29.83, respectively. The results of Cox proportional hazards regression showed that compared with the Q1 group, the incidence of arterial stiffness in cumCVH among Q2, Q3, and Q4 groups decreased by 11%, 19%, and 22%, respectively. Sensitivity analyses showed consistency with the main results.

CONCLUSIONS

High cumCVH can delay the progression of arterial stiffness and reduce the risk of developing arterial stiffness.

Association of early life adversity with cardiovascular disease and its potential mechanisms: a narrative review

Strong epidemiological evidence has shown that early life adversity (ELA) has a profound negative impact on health in adulthood, including an increased risk of cardiovascular disease, the leading cause of death worldwide. Here, we review cohort studies on the effects of ELA on cardiovascular outcomes and the possible underlying mechanisms. In addition, we summarize relevant studies in rodent models of ELA. This review reveals that the prevalence of ELA varies between regions, time periods, and sexes. ELA increases cardiovascular health risk behaviors, susceptibility to mental illnesses, and neuroendocrine and immune system dysfunction in humans. Rodent models of ELA have been developed and show similar cardiovascular outcomes to those in humans but cannot fully replicate all ELA subtypes. Therefore, combining cohort and rodent studies to further investigate the mechanisms underlying the association between ELA and cardiovascular diseases may be a feasible future research strategy.

Sleep and cardiovascular disease

This review centres around the recent evidence in examining the intersection of sleep and cardiovascular disease (CVD). Sleep in this review will be further subdivided to consider both sleep quantity and quality along and will also consider some of the more common sleep disorders, such as insomnia and obstructive sleep apnoea, in the context of CVD. Sleep disorders have been further explored in several specific populations which are both at risk of sleep disorders and CVD. Secondly, the review will present some of the risk factors for CVD that are affected by sleep and sleep disorders which include hypertension, diabetes, and obesity. It will also examine the potential underlying mechanisms including inflammation, appetite control, endocrine, and genetic processes that are affected by sleep and sleep disorders leading to increased risk of CVD development. In addition, we will consider the observed bi-directional relationships between sleep and cardiovascular risk factors. For example, obesity, a risk factor for CVD can be affected by sleep, but in turn can increase the risk of certain sleep disorder development which disrupts sleep, leading to further risk of obesity development and increased CVD risk. Finally, the review will explore emerging evidence around lifestyle interventions that have included a sleep component and how it impacts the management of CVD risk factor. The need for increased awareness of the health effects of poor sleep and sleep disorders will be discussed alongside the need for policy intervention to improve sleep to facilitate better health and well-being.

The 24-h activity cycle and cardiovascular outcomes: establishing biological plausibility using arterial stiffness as an intermediate outcome

This review proposes a biologically plausible working model for the relationship between the 24-h activity cycle (24-HAC) and cardiovascular disease. The 24-HAC encompasses moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior (SB), and sleep. MVPA confers the greatest relative cardioprotective effect, when considering MVPA represents just 2% of the day if physical activity guidelines (30 min/day) are met. While we have well-established guidelines for MVPA, those for the remaining activity behaviors are vague. The vague guidelines are attributable to our limited mechanistic understanding of the independent and additive effects of these behaviors on the cardiovascular system. Our proposed biological model places arterial stiffness, a measure of vascular aging, as the key intermediate outcome. Starting with prolonged exposure to SB or static standing, we propose that the reported transient increases in arterial stiffness are driven by a cascade of negative hemodynamic effects following venous pooling. The subsequent autonomic, metabolic, and hormonal changes further impair vascular function. Vascular dysfunction can be offset by using mechanistic-informed interruption strategies and by engaging in protective behaviors throughout the day. Physical activity, especially MVPA, can confer protection by chronically improving endothelial function and associated protective mechanisms. Conversely, poor sleep, especially in duration and quality, negatively affects hormonal, metabolic, autonomic, and hemodynamic variables that can confound the physiological responses to next-day activity behaviors. Our hope is that the proposed biologically plausible working model will assist in furthering our understanding of the effects of these complex, interrelated activity behaviors on the cardiovascular system.

Bedtime, sleep duration, and sleep quality and all-cause mortality in middle-aged and older Chinese adults: The Dongfeng-Tongji cohort study

OBJECTIVE

This study aims to investigate the associations of bedtime and its combination with sleep duration and sleep quality with all-cause mortality.

METHODS

We conducted a prospective cohort study using data collected from 2008 to 2018 in the Dongfeng-Tongji cohort. Among 40,097 participants aged 62.1 on average at baseline, we applied Cox regression models to assess hazard ratios and 95% confidence intervals for mortality risk.

RESULTS

During a mean follow-up of 8.2years, 4345 deaths were documented. U-shaped associations of bedtime and sleep duration with all-cause mortality were observed. Compared with bedtime between 10:01 PM and 11:00 PM, the hazard ratio (95% confidence interval) for all-cause mortality was 1.34 (1.20-1.49) for ≤9:00 PM, 1.18 (1.09-1.27) for 9:01-10:00 PM, and 1.50 (1.13-2.00) for >12:00 AM, respectively. Participants with sleep duration of <6, 6-<7, 8-<9, and ≥9 h/night had a respective 39%, 21%, 11%, and 25% higher all-cause mortality risk than those sleeping 7-<8 h/night. Additionally, participants with a healthy sleep score of 3, characterized as proper bedtime (10:01 PM-12:00 AM), moderate sleep duration (7-<8h/night), and good/fair sleep quality, had a significantly 36% (hazard ratio, 0.64; 95% confidence interval, 0.56-0.74) lower all-cause mortality risk than those with a score of 0.

CONCLUSIONS

Individuals with early or late bedtimes and short or long sleep duration were at higher all-cause mortality risks. Having healthy sleep habits may significantly reduce death risk.

Arterial stiffness and the reallocation of time between device-measured 24-hour movement behaviours: A compositional data analysis

BACKGROUND AND AIMS

Arterial stiffness predicts cardiovascular morbidity and mortality. We aimed to quantify the differences in arterial stiffness associated with reallocating time between 24-h movement behaviours.

METHODS

This observational cross-sectional study included Luxembourg residents aged 25-79y who each provided ≥4 valid days of triaxial accelerometry (n = 1001). Covariable adjusted compositional isotemporal substitution models were used to examine if theoretical reallocations of time between device-measured sedentariness, the sleep period, light physical activity (PA), and moderate-to-vigorous PA (MVPA) were associated with the percentage difference in carotid-femoral pulse wave velocity (cfPWV). We further investigated if replacing sedentary time accumulated in prolonged (≥30 min) with non-prolonged (<30 min) bouts was associated with arterial stiffness. The results are presented as 30 min time exchanges (β (95% confidence interval)).

RESULTS

Beneficial associations with lower cfPWV were observed when reallocating time to MVPA from the sleep period (-1.38 (-2.63 to -0.12) %), sedentary time (-1.70 (-2.76 to -0.62) %), and light PA (-2.51 (-4.55 to -0.43) %), respectively. Larger associations in the opposite direction were observed when reallocating MVPA to the same behaviours (for example, replacing MVPA with sedentary time: 2.50 (0.85-4.18) %). Replacing prolonged with non-prolonged sedentary time was not associated with cfPWV (-0.27 (-0.86 to 0.32) %). In short sleepers, reallocating sedentary time to the sleep period was favourable (-1.96 (-3.74 to -0.15) %).

CONCLUSIONS

Increasing or at least maintaining MVPA appears to be important for arterial health in adults. Extending sleep in habitually short sleepers, specifically by redistributing sedentary time, may also be important.

Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis

Objectives: To summarize the evidence on the association between sleep problems and multimorbidity. Methods: Six electronic databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, and Wan fang) were searched to identify observational studies on the association between sleep problems and multimorbidity. A random-effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals for multimorbidity. Results: A total of 17 observational studies of 133,575 participants were included. Sleep problems included abnormal sleep duration, insomnia, snoring, poor sleep quality, obstructive sleep apnea (OSA) and restless legs syndrome (RLS). The pooled ORs (95% CIs) for multimorbidity were 1.49 (1.24-1.80) of short sleep duration, 1.21 (1.11-1.44) of long sleep duration and 2.53 (1.85-3.46) for insomnia. The association of other sleep problems with multimorbidity was narratively summarized due to limited number of comparable studies. Conclusion: Abnormal sleep duration and insomnia are associated with higher odds of multimorbidity, while the evidence on association of snoring, poor sleep quality, obstructive sleep apnea and restless legs syndrome with multimorbidity remains inconclusive. Interventions targeting sleep problems should be delivered for better management of multimorbidity.

Childhood Obesity and Cardiovascular Disease Risk

PURPOSE OF REVIEW

The global epidemic of youth-onset obesity is tightly linked to the rising burden of cardiometabolic disease across the lifespan. While the link between childhood obesity and cardiovascular disease is established, this contemporary review summarizes recent and novel advances in this field that elucidate the mechanisms and impact of this public health issue.

RECENT FINDINGS

The review highlights the emerging data supporting the relationship between childhood adverse events, social determinants of health, and systemic and institutional systems as etiological factors. We also provide updates on new screening and treatment approaches including updated nutrition and dietary guidelines and benchmarks for pediatric obesity screening, novel pharmacological agents for pediatric obesity and type 2 diabetes such as glucagon-like 1 peptide receptor agonists, and we discuss the long-term safety and efficacy data on surgical management of pediatric obesity. The global burden of pediatric obesity continues to rise and is associated with accelerated and early vascular aging especially in youth with obesity and type 2 diabetes. Socio-ecological determinants of risk mediate and moderate the relationship of childhood obesity with cardiometabolic disease. Recognizing the importance of neighborhood level influences as etiological factors in the development of cardiovascular disease is critical for designing effective policies and interventions. Novel surgical and pharmacological interventions are effective pediatric weight-loss interventions, but future research is needed to assess whether these agents, within a socio-ecological framework, will be associated with abatement of the pediatric obesity epidemic and related increased cardiovascular disease risk.

Association between organophosphorus insecticides exposure and the prevalence of sleep problems in the US adults: An analysis based on the NHANES 2007-2018

OBJECTIVE

The aim of this study was to evaluate the association between organophosphorus pesticides (OPPs) exposure and sleep problems.

METHODS

In this study, data from 6295 participants aged 18 years or older were collected from the National Health and Nutrition Examination Survey (NHANES). The dialkyl phosphate compounds (DAPs) metabolites, OPPs exposure biomarker, were examined using solid phase extraction-high coupled with isotope dilution-ultrahigh performance liquid chromatography-tandem mass spectrometry. Data on short sleep duration (SSD), self-reported trouble sleeping and self-reported sleep disorder were collected from the database. Weighted generalized logistic model, weighted quantile sum (WQS) model, and quantile-based g calculation (QGC) methods were used for analyzing the collected data.

RESULTS

The prevalence of SSD, self-reported trouble sleeping and self-reported sleep disorder in this study were 28.91 % (1814/6274), 25.31 % (1593/6294), and 9.05 % (289/3195), respectively. After confounding factors adjustments, the prevalence of SDD in participants with high log-transformed DETP, DMTP, DEDTP, and DMDTP were 1.19 times (OR: 1.11-1.28, P < 0.001), 1.09 times (OR: 1.03-1.15, P = 0.003), 1.26 times (OR: 1.17-1.37, P < 0.0001), and 1.10 times (OR: 1.04-1.17, P = 0.003) than in participants with low showed, respectively. A non-linear relationship was noted between SSD with the urinary concentration of DEP (P for nonlinearity < 0.001), DMP (P for nonlinearity < 0.001), DMTP (P for nonlinearity = 0.006), and DMDTP (P for nonlinearity = 0.001). The WQS results showed that the prevalence of SDD was 1.28 times (95 % CI: 1.17-1.40, P < 0.001) higher in participants with high co-exposure to OPPs than in those with low co-exposure, with DEDTP having the enormous weights (0.50). The QGC results also revealed a significant positive association between the co-exposure of DAPs and SSD (OR: 1.08, 95 % CI:1.02-1.16, P = 0.01) with DETP having the most positive weight (0.44). As for the association between DAPs with self-report sleep disorder, only DEP was detected that it was positively associated with self-reported sleep disorder with all confounding factors adjusted (OR: 1.17; 95 % CI: 1.07-1.29, P = 0.001). However, all DAPs have not detected a significant association with the prevalence of self-reported trouble sleeping. Besides, there was no significant association between co-exposure to OPPs with self-reported trouble sleeping and self-reported sleep disorder.

CONCLUSION

The results of this study indicated that high levels of single or mixture urinary DAP, indicating for OPPs exposure, were associated with an increased prevalence of SSD in general adults, which has significant implications for preventing OPPs pollution and protecting sleep health.