Poor sleep health was associated with increased risk for experiencing CVD, according to data published in Scientific Reports.

Researchers reported that for each component (regularity, satisfaction, alertness, efficiency, duration and sleep actigraphy) of a composite sleep health measure, participants experienced an incrementally larger risk for CVD compared with those with healthy sleep.

“Insufficient or poor sleep is a significant risk factor for heart disease. Studies have mostly used single sleep measures (often focusing only on sleep duration, quality or insomnia). However, a composite of multidimensional sleep health may be more predictive of heart disease than single sleep measures,” Soomi Lee, PhD, assistant professor in the College of Behavioral and Community Sciences at the University of South Florida School of Aging Studies, and colleagues wrote. “Our approach lends itself to characterizing a ‘sleep health’ message that will be more effective in motivating the public to engage in multiple sleep health behaviors that may have synergistic effects on decreasing the risk of heart disease.”

For this study, researchers utilized the data of 6,820 individuals (mean age, 53 years) from the Midlife in the U.S. study (MIDUS) to evaluate whether composite measures of sleep health were associated with CVD. Researchers assessed two sleep health composites: the first, based on self-report only, assessed regularity, satisfaction, alertness, efficiency and duration of sleep; the second was based on each of the previous self-reported variables plus sleep actigraphy.

The outcome of CVD was also self-reported (MI, angina, valvular disease, atrial septal defect, ventricular septal defect, CAD, CHD, ischemia, arrhythmia, heart murmur, HF and/or other). Hypertension was excluded as a sleep health-related CVD.

Sleep health and CVD risk

After full adjustment, researchers reported a significant association between self-reported sleep health and risk for heart disease, with each unit increase in measures of poor sleep health associated with a 54% greater risk for CVD (adjusted RR = 1.54; P < .001). For each unit increase in measures of poor sleep health from the second composite including actigraphy, researchers observed a 141% greater risk for CVD (aRR = 2.41; P < .001).

Lee and colleagues proceeded to conduct a sensitivity check using unweighted sleep health composites and reported generally consistent yet weaker findings, with a 14% greater risk for CVD with each additional dimension of poor sleep (aRR = 1.14; P < .001). The association between poor sleep health and CVD failed to meet statistical significance in the sensitivity check using the unweighted self-reported second composite plus actigraphy (aRR = 1.22; P = .073).

Subgroup analyses by sex and race

Lee and colleagues noted that women reported more sleep health problems based on the first composite but not the second composite that included actigraphy. Although men were more likely to report CVD compared with women, sex did not moderate the association between sleep health and risk for CVD.

Although Black individuals experienced the highest number of unhealthy sleep variables and the highest prevalence of CVD, researchers reported that sleep health and CVD risk were more strongly related in white participants compared with all other races in the self-reported second composite plus actigraphy (P = .001).

Moreover, the slope for the association between more sleep health problems and increased risk for CVD was similar between both Black and white participants (P = .151), but other races and ethnicities did not follow the same pattern.

“The current study shows the importance of considering ‘co-existing sleep health problems’ within an individual to assess the risk of heart disease,” the researchers wrote. “Findings revealed having more sleep health problems may increase the risk of heart disease in middle adulthood. Results were consistent between two independent samples using different sleep health composites (using self-report only and both actigraphy and self-report). Despite known differences in the prevalence of sleep and heart disease by sex and race, the association between sleep health and the risk of heart disease did not generally differ by sex and race in our study. The findings highlight the importance and utility of assessing multidimensional sleep health in predicting the risk of heart disease and potentially other health outcomes.”