Author + information
- Received July 17, 2018
- Revision received October 9, 2018
- Accepted October 12, 2018
- Published online January 14, 2019.
- Fernando Domínguez, MD, PhDa,b,c,
- Valentín Fuster, MD, PhDa,d,∗∗ (, )@CNIC_Cardio@MountSinaiNYC,
- Juan Miguel Fernández-Alvira, PhDa,
- Leticia Fernández-Friera, MD, PhDa,c,e,
- Beatriz López-Melgar, MD, PhDa,c,e,
- Ruth Blanco-Rojo, PhDf,
- Antonio Fernández-Ortiz, MD, PhDa,c,g,h,
- Pablo García-Pavía, MD, PhDb,c,i,
- Javier Sanz, MDa,d,
- José M. Mendiguren, MDj,
- Borja Ibañez, MD, PhDa,c,k,
- Héctor Bueno, MD, PhDa,l,m,
- Enrique Lara-Pezzi, PhDa,c and
- José M. Ordovás, PhDa,f,n,∗ (, )@jordovas56
- aCentro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- bHeart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- cCentro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- dZena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
- eHM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
- fIMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
- gUniversidad Complutense, Madrid, Spain
- hCardiovascular Institute, IDSSC, Hospital Clínico San Carlos, Madrid, Spain
- iFaculty of Health Sciences, University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Madrid, Spain
- jBanco de Santander, Madrid, Spain
- kIIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
- lCardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
- mFacultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- nU.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. José M. Ordovás, Nutrition and Genomics, Nutrition and Genetics, JM-USDA-HNRCA at Tufts University, 711 Washington Street, Boston, Massachusetts 02111.
- ↵∗∗Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, 1190 5th Avenue, New York, New York 10029.
Background Sleep duration and quality have been associated with increased cardiovascular risk. However, large studies linking objectively measured sleep and subclinical atherosclerosis assessed in multiple vascular sites are lacking.
Objectives The purpose of this study was to evaluate the association of actigraphy-measured sleep parameters with subclinical atherosclerosis in an asymptomatic middle-aged population, and investigate interactions among sleep, conventional risk factors, psychosocial factors, dietary habits, and inflammation.
Methods Seven-day actigraphic recording was performed in 3,974 participants (age 45.8 ± 4.3 years; 62.6% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study. Four groups were defined: very short sleep duration <6 h, short sleep duration 6 to 7 h, reference sleep duration 7 to 8 h, and long sleep duration >8 h. Sleep fragmentation index was defined as the sum of the movement index and fragmentation index. Carotid and femoral 3-dimensional vascular ultrasound and cardiac computed tomography were performed to quantify noncoronary atherosclerosis and coronary calcification.
Results When adjusted for conventional risk factors, very short sleep duration was independently associated with a higher atherosclerotic burden with 3-dimensional vascular ultrasound compared to the reference group (odds ratio: 1.27; 95% confidence interval: 1.06 to 1.52; p = 0.008). Participants within the highest quintile of sleep fragmentation presented a higher prevalence of multiple affected noncoronary territories (odds ratio: 1.34; 95% confidence interval: 1.09 to 1.64; p = 0.006). No differences were observed regarding coronary artery calcification score in the different sleep groups.
Conclusions Lower sleeping times and fragmented sleep are independently associated with an increased risk of subclinical multiterritory atherosclerosis. These results highlight the importance of healthy sleep habits for the prevention of cardiovascular disease.
The PESA study is cofunded equally by the CNIC and Banco Santander. The study also receives funding from the Institute of Health Carlos III (PI15/02019) and the European Regional Development Fund. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MEIC) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (MEIC award SEV-2015-0505). Dr. Bueno has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; has received speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Ferrer, Novartis, and MEDSCAPE-the heart.org; and has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 and PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 17, 2018.
- Revision received October 9, 2018.
- Accepted October 12, 2018.