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Francesco P. Cappuccio, Daniel Cooper, Lanfranco D'Elia, Pasquale Strazzullo, Michelle A. Miller, Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies, European Heart Journal, Volume 32, Issue 12, June 2011, Pages 1484–1492, https://doi.org/10.1093/eurheartj/ehr007
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Abstract
To assess the relationship between duration of sleep and morbidity and mortality from coronary heart disease (CHD), stroke, and total cardiovascular disease (CVD).
We performed a systematic search of publications using MEDLINE (1966–2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. Studies were included if they were prospective, follow-up >3 years, had duration of sleep at baseline, and incident cases of CHD, stroke, or CVD. Relative risks (RR) and 95% confidence interval (CI) were pooled using a random-effect model. Overall, 15 studies (24 cohort samples) included 474 684 male and female participants (follow-up 6.9–25 years), and 16 067 events (4169 for CHD, 3478 for stroke, and 8420 for total CVD). Sleep duration was assessed by questionnaire and incident cases through certification and event registers. Short duration of sleep was associated with a greater risk of developing or dying of CHD (RR 1.48, 95% CI 1.22–1.80, P < 0.0001), stroke (1.15, 1.00–1.31, P = 0.047), but not total CVD (1.03, 0.93–1.15, P = 0.52) with no evidence of publication bias (P = 0.95, P = 0.30, and P = 0.46, respectively). Long duration of sleep was also associated with a greater risk of CHD (1.38, 1.15–1.66, P = 0.0005), stroke (1.65, 1.45–1.87, P < 0.0001), and total CVD (1.41, 1.19–1.68, P < 0.0001) with no evidence of publication bias (P = 0.92, P = 0.96, and P = 0.79, respectively).
Both short and long duration of sleep are predictors, or markers, of cardiovascular outcomes.
Comments
Cappuccio et al conducted a systematic review and meta-analysis for the effect of sleep duration on cardiovascular diseases (1). They could not consider on the perception of sleep quality for the analysis because of lack of information. Appropriate sleep duration differs from person to person, and there is no standard or reference value for sleep duration to predict human health.
I do not think that physiological apparatus such as actigraphy has an advantage to monitor sleep duration compared with self-reporting sleep duration to minimize measurement error (2). Appropriate adjustment of aging effect on arterial stiffness is difficult for epidemiological study, although problems on obstructive sleep apnea syndrome and depressive state should be handles with caution (3).
Puttonen et al. recently presented model pathway that circadian stress such as shift work would become trigger of psychological overload and behavioral change of life including sleep quality and length (4). From this schema, the author speculates that sleep duration and arterial stiffness is not directly related and many physical and mental factors would relate to vascular stress or overload, which finally relates to sleep quality and duration.
References
1. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta- analysis of prospective studies. Eur Heart J 2011;32:1484-1492.
2. Kawada T. Accuracy of wrist accelerometer during nap sleep in subjects with a variety of sleep efficiencies. J Pain Symptom Manage 2011;42:e9- e10.
3. Dowd JB, Goldman N, Weinstein M. Sleep duration, sleep quality, and biomarkers of inflammation in a Taiwanese population. Ann Epidemiol. 2011;21:799-806.
4. Puttonen S, Harma M, Hublin C. Shift work and cardiovascular disease - pathways from circadian stress to morbidity. Scand J Work Environ Health 2010;36:96-108.
Conflict of Interest:
None declared