Multidimensional sleep health related to better cardio-metabolic outcomes

Healthy sleep includes multiple components, including how many hours of sleep per night, how long it takes to fall asleep, daytime functioning and self-reported sleep satisfaction, and addressing these different aspects of sleep could help reduce cardiac metabolic health and associated risk factors, according to a new American Heart Association scientific statement released today. Circulation: Cardiovascular quality and results.

The new scientific statement, “Multidimensional Sleep Health: Definition and Meaning of Heart Metabolic Health,” describes multiple factors of sleep health, including sleep duration, continuity, timing, satisfaction, regularity, and daytime functioning. The scientific statement also reviews what is known about the relationship between sleep and various cardiometabolic factors, including body fat, blood sugar, cholesterol, and blood pressure, as well as the latest evidence on how healthy sleep has a positive effect on physical and mental health.

Most adults need 7-9 hours of sleep each night, and the next sleep increases the risk of cardiovascular disease and runs the risk of cognitive decline, depression, obesity, hypertension, blood glucose and cholesterol levels. However, there is growing evidence that sleep health requires about more sleep hours each night. ”

Marie-Pierre St-Onge, Ph.D., CCSH, FAHA, Chair of the Science Statement Writing Group, Associate Professor of Nutritional Medicine, Director of the Medical School and Center for Excellence, Sleep & Circadian Research Center, Columbia University Irving Medical Center in New York City

Sleep and heart and metabolism health

According to a scientific statement, a single aspect of sleep health does not fully capture people's sleep experiences and how individual bodies respond. The poorly discernible and less-studied components of sleep health are related to sleep experiences and contribute to overall physical and mental health and well-being. The sleep components are:

• Sleep time The number of hours per night (or 24 hours) that an individual will sleep. It is estimated via self-reported hours of those who spent using surveys or diaries to get sleep, or is objectively assessed via actiography (woman wearing a device that tracks movement) or polysomnography (watching sleep using sensors to measure brain activity, breathing, blood oxygen, and eye movement). Latest evidence from multiple studies shows that sleep less than 7 hours per night increases the risk of atrial fibrillation syndrome (a group of conditions that increase the likelihood of type 2 diabetes, heart disease or stroke) and blood pressure not lowered during sleep/need to fall/night/night/when sleep and active and active during sleep). Too much sleep or more than 9 hours per night is also associated with an increased risk of cardiovascular syndrome, stiff arteries, stroke or death due to heart disease or stroke.

• Continuity of sleep The percentage of time spent on sleep. The amount of time it takes to fall asleep, the number of times you wake up during the night, and the amount of time you wake up at night (after you fall asleep) are calculated based on factors that represent sleep disorders, such as unexpected early awakening and obstructive sleep apnea. Disruption in sleep continuity is associated with a higher risk of atrial fibrillation, heart attack, hypertension, or more insulin resistance.

• Sleep timing It refers to the time when a person usually falls asleep within 24 hours. Studies assessing sleep timing will examine how cardiac metabolic risks change during a person's normal bedtime, and whether they sleep during the daytime and during the daytime. Although there are limited high-quality studies on sleep timing, data show that suboptimal timing of sleep is likely to be associated with an increased risk factor for cardiovascular disease. Reported bedtime after midnight is associated with higher risk of overweight or obesity, insulin resistance, and increased blood pressure compared to after midnight.

• Sleep satisfaction It is a person's own perception of sleep experience. Combined analysis of recent studies shows that lower sleep satisfaction is associated with higher blood pressure, stiffer, less flexible arteries, coronary heart disease, and nocturne blood pressure at night.

• Regularity of sleep A person's sleep duration/timing stability spans days (for example, if sleep times change between work days and weekends, this is called a “social jet lag”). Social jet lag is associated with a 20% higher risk of overweight or obesity, and daily variation in sleep timing is associated with a higher risk of cardiovascular disease and hypertension. inflammationObesity and blood pressure do not decrease at night. Large studies have shown that greater consistency in sleep-wake timing is associated with a 22% to 57% lower risk of cardiovascular death. On a large scale UK biobank Research, irregular sleep timing was associated with the highest risk among people who had adequate sleep, even those who had high sleep, and who had too little sleep and had very irregular sleep patterns.

• Sleep-related daytime features is the ability of a person to remain vigilant and awake during the day (including sleepiness and fatigue). Participants' self-reported information can be estimated by assessing their likelihood of falling asleep in a particular situation (such as watching TV or getting into a car) or by assessing a person's cognitive vigilance (such as testing reaction times for visual or auditory cues). Excessive daytime drowsiness is associated with death from both cardiovascular disease, coronary heart disease, stroke, cardiovascular disease and all causes. Certain cardiovascular risks, such as obesity, type 2 diabetes, depression, smoking, and obstructive sleep apnea, were associated with a higher risk of daytime drowsiness, but weight loss appeared to reduce excessive daytime drowsiness.

• Sleep architecture It refers to the stage of sleep in which the body frequently circulates while sleeping to measure electrical activity in the brain using brain EEG. Sleep is divided into two categories. Non-strength eye movement (NREM), including stages of light sleep and deep sleep. Rapid Eye Movement (REM), the deepest stage of sleep. Disruption in the continuity of sleep can interfere with the stage of sleep in different ways. One analysis of the combined study points out that NREM interruption, also known as slow wave sleep, led to higher levels of insulin resistance compared to non-broken sleep.

The difference in sleep health

The statement also addresses differences in sleep health in people affected by unfavorable social factors in health. A recent review of over 300 studies found a consistent link between lower socioeconomic status and suboptimal sleep health. Social and environmental factors, including household and neighborhood characteristics such as light, air, noise pollution, and safety, also contribute to the difference in one or more factors of sleep health.

Compared to non-Hispanic whites, individuals from historically underrepresented racial and ethnic groups are more likely to have fewer sleep, lower sleep continuity, lower sleep satisfaction, later sleep, irregular sleep, higher daytime sleepiness, and increased incidence of sleep disorders. These differences are observed throughout life span and persist over time, with black adults having the worst sleep health of all.

“It is important to know that every individual has a different sleep experience, and these differences can contribute to other health inequalities,” St-Onge said. “Including various elements of sleep in discussions with patients provides important information that will help healthcare professionals improve their care.”

Asking questions like, “How long does it usually take to fall asleep each night?”, “How many times do you wake up in the middle of the night?” and “How often do you feel tired during the day?”, you can give patients the opportunity to share their concerns about their sleep experience and quality of sleep. Documenting sleep details in a patient's medical record can help inform the patient's health care team about the patient's sleep health and may encourage a more detailed assessment or screening. This information can also be useful when considering how a patient's health and prescription drug regimen may interfere with sleep health, and should be adjusted or changed.

“While some changes in sleep throughout the life course are natural, individuals should not accept sleep deprivation or worsening as a 'fact of life' or an inevitable consequence of the aging process. New difficulties should be discussed with your doctor for further evaluation and potential treatment, such as continuing to sleep or sleep, maintaining excessive sleepiness.

More research was needed to optimize sleep health

While awareness of the importance of sleep is growing, more research is needed on various aspects of sleep health so clinicians can support patients in ways that promote healthy sleep and improve their health. There are many smartwatches and other personal devices available to track the amount of time spent sleeping per night, but advances are being made in other ways of assessing sleep dimensions. Using data from both self-report and objective measures can help ensure that sleep health guidance is based on reliable and comprehensive information.

Sleep is one of the health indicators pointed out in Life's Essential 8, an American Heart Association's measure for optimal cardiovascular health. When incorporating sleep into life's essential 8 scores, the only measure of sleep is the duration (hours per night) as there are still no adequately validated studies to confirm how other sleep components are evaluated.

Several research studies have found that low sleep health (such as short sleep durations and irregular sleep schedules) contribute to adverse cardiovascular outcomes. Evidence from clinical trials confirming that improving sleep health improves cardio-metabolic health. This data helps people develop effective interventions that help them improve various factors of sleep.

Research on multidimensional sleep health includes collaboration across medical specialties, including sleep medicine, cardiology, endocrinology, gastroenterology, nephrology, respiratory and neurology. Additionally, individuals from underrepresented racial and ethnic groups should be included in the study to capture various factors of sleep health in diverse populations and communities. A broader understanding and tested research into the effects of sleep on the physical and mental well-being of sleep is key to advance cardiovascular health for all.

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association's Council on Lifestyle and Heart Metabolic Health. Cardiovascular and Stroke Nursing Council. Clinical Cardiology Council. Research Council on quality and outcomes of care.