Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Zena 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.
J Am Coll Cardiol. 2019 Jan 22;73(2):134-144. doi: 10.1016/j.jacc.2018.10.060.
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.
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.
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.
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.
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.
睡眠时长和质量与心血管风险增加有关。然而，缺乏针对多个血管部位进行的、将客观测量的睡眠与亚临床动脉粥样硬化联系起来的大型研究。
本研究旨在评估在无症状中年人群中，基于活动记录仪测量的睡眠参数与亚临床动脉粥样硬化之间的关联，并探讨睡眠、传统危险因素、心理社会因素、饮食习惯和炎症之间的相互作用。
在 PESA（早期亚临床动脉粥样硬化进展）研究中，对 3974 名参与者（年龄 45.8±4.3 岁，62.6%为男性）进行了为期 7 天的活动记录仪记录。将参与者分为四组：极短睡眠组（<6 小时）、短睡眠组（6 至 7 小时）、参考睡眠组（7 至 8 小时）和长睡眠组（>8 小时）。睡眠碎片化指数定义为运动指数和碎片化指数之和。进行颈动脉和股动脉 3 维血管超声及心脏计算机断层扫描以量化非冠状动脉粥样硬化和冠状动脉钙化。
在校正传统危险因素后，与参考组相比，极短睡眠组与 3 维血管超声检测到的更高的动脉粥样硬化负担相关（比值比：1.27；95%置信区间：1.06 至 1.52；p=0.008）。睡眠碎片化程度最高五分位组的多部位非冠状动脉病变发生率较高（比值比：1.34；95%置信区间：1.09 至 1.64；p=0.006）。不同睡眠组的冠状动脉钙化评分无差异。
睡眠时间较短和睡眠碎片化与亚临床多部位动脉粥样硬化风险增加独立相关。这些结果强调了健康睡眠习惯对预防心血管疾病的重要性。
