Title

Association of Subjective and Objective Sleep Duration as well as Sleep Quality with Non-Invasive Markers of Sub-Clinical Cardiovascular Disease (CVD): A Systematic Review

Authors

Muhammad Aziz, Baptist Health South Florida; Benedictine University
Shozab S. Ali, Baptist Health South Florida; University of Manchester School of Medicine
Sankalp Das, Baptist Health South Florida
Adnan Younus, Baptist Health South Florida
Rehan Malik, Baptist Health South Florida
Muhammad A. Latif, Baptist Health South Florida
Choudhry Humayun, Baptist Health South Florida
Dixitha Anugula, Creighton University Medical Center
Ghulam Abbas, Howard University Health Sciences
Joseph Salami, Baptist Health South Florida
Javier Valero Elizondo, Baptist Health South Florida
Emir Veledar, Baptist Health South Florida; Florida International UniversityFollow
Khurram Nasir, Department of Epidemiology and the Herbert Wertheim College of Medicine, Florida International University; Baptist Health Medical Group; The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseFollow

Date of this Version

2017

Document Type

Article

Abstract

Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity& mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remains less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD.

Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality Index (PSQI) or via objective methods, as actigraphy or polysomnography or by both. Among subclinical CVD measures, coronary artery calcium (CAC) was measured by electron beam computed tomography, Carotid intima-media thickness (CIMT) measured by high-resolution B-mode ultrasound on carotid arteries, endothelial/microvascular function measured by flow mediated dilation (FMD) or peripheral arterial tone (PAT) or iontophoresis or nailfold capillaroscopy, and arterial stiffness measured by pulse wave velocity (PWV) or ankle brachial index (ABI).

Results: Subjective short sleep duration was associated with CAC and CIMT, but variably associated with endothelial dysfunction (ED) and arterial stiffness; however, subjective long sleep duration was associated with CAC, CIMT and arterial stiffness, but variably associated with ED. Objective short sleep duration was positively associated with CIMT and variably with CAC but not associated with ED. Objective long sleep duration was variably associated with CAC and CIMT but not associated with ED. Poor subjective sleep quality was significantly associated with ED and arterial stiffness but variably associated with CAC and CIMT. Poor objective sleep quality was significantly associated with CIMT, and ED but variably associated with CAC.

Conclusions: Overall, our review provided mixed results, which is generally in line with published literature, with most of the studies showing a significant relationship with subclinical CVD, but only some studies failed to demonstrate such an association. Although such mechanistic relationship needs further evaluation in order to determine appropriate screening strategies in vulnerable populations, this review strongly suggested the existence of a relationship between abnormal sleep duration and quality with increased subclinical CVD burden.

Comments

Originally published in the Journal of Atherosclerosis and Thrombosis .

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Recommended Citation

Aziz, Muhammad; Ali, Shozab S.; Das, Sankalp; Younus, Adnan; Malik, Rehan; Latif, Muhammad A.; Humayun, Choudhry; Anugula, Dixitha; Abbas, Ghulam; Salami, Joseph; Valero Elizondo, Javier; Veledar, Emir; and Nasir, Khurram, "Association of Subjective and Objective Sleep Duration as well as Sleep Quality with Non-Invasive Markers of Sub-Clinical Cardiovascular Disease (CVD): A Systematic Review" (2017). Department of Biostatistics Faculty Publications. 16.
https://digitalcommons.fiu.edu/biostatistics_fac/16