Huang Tianyi, Mariani Sara, Redline Susan
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2020 Mar 10;75(9):991-999. doi: 10.1016/j.jacc.2019.12.054.
The cardiovascular system exhibits strong circadian rhythms to maintain normal functioning. Irregular sleep schedules, characterized by high day-to-day variability in sleep duration or timing, represent possibly milder but much more common and chronic disruption of circadian rhythms in the general population than shift work.
This study aimed to prospectively examine the association between sleep regularity and risk of cardiovascular disease (CVD).
In MESA (Multi-Ethnic Study of Atherosclerosis), 1,992 participants free of CVD completed 7-day wrist actigraphy for sleep assessment from 2010 to 2013 and were prospectively followed through 2016. The study assessed sleep regularity using the SD of actigraphy-measured sleep duration and sleep-onset timing across 7 days. Incident CVD included nonfatal and fatal cardiovascular events. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for incident CVD according to SD of sleep duration and timing, adjusted for traditional CVD risk factors (including CVD biomarkers) and other sleep-related factors (including average sleep duration).
During a median follow-up of 4.9 years, 111 participants developed CVD events. The multivariable-adjusted HRs (95% confidence intervals) for CVD across categories of sleep duration SD were 1.00 (reference) for ≤60 min, 1.09 (0.62 to 1.92) for 61 to 90 min, 1.59 (0.91 to 2.76) for 91 to 120 min, and 2.14 (1.24 to 3.68) for >120 min (p trend = 0.002). Similarly, compared with participants with a sleep timing SD ≤30 min, the HRs (95% confidence intervals) for CVD were 1.16 (0.64 to 2.13) for 31 to 60 min, 1.52 (0.81 to 2.88) for 61 to 90 min, and 2.11 (1.13 to 3.91) for >90 min (p trend = 0.002). Exclusion of current shift workers yielded similar results.
Irregular sleep duration and timing may be novel risk factors for CVD, independent of traditional CVD risk factors and sleep quantity and/or quality.
心血管系统呈现出强烈的昼夜节律以维持正常功能。睡眠时间表不规律，表现为睡眠时间或时间安排的日常变化较大，在普通人群中可能代表比轮班工作更轻微但更常见且长期的昼夜节律紊乱。
本研究旨在前瞻性地研究睡眠规律性与心血管疾病（CVD）风险之间的关联。
在动脉粥样硬化多民族研究（MESA）中，1992名无CVD的参与者在2010年至2013年期间完成了为期7天的手腕活动监测以进行睡眠评估，并前瞻性随访至2016年。该研究使用活动监测测量的7天睡眠持续时间和入睡时间的标准差来评估睡眠规律性。新发CVD包括非致命性和致命性心血管事件。使用Cox比例风险模型根据睡眠持续时间和时间的标准差估计新发CVD的风险比（HR），并对传统CVD危险因素（包括CVD生物标志物）和其他与睡眠相关的因素（包括平均睡眠时间）进行调整。
在中位随访4.9年期间，111名参与者发生了CVD事件。睡眠持续时间标准差各分类中CVD的多变量调整HR（95%置信区间），≤60分钟为1.00（参考值），61至90分钟为1.09（0.62至1.92），91至120分钟为1.59（0.91至2.76），>120分钟为2.14（1.24至3.68）（p趋势=0.002）。同样，与入睡时间标准差≤30分钟的参与者相比，入睡时间标准差为31至60分钟时CVD的HR（95%置信区间）为1.16（0.64至2.13），61至90分钟为1.52（0.81至2.88），>90分钟为2.11（1.13至3.91）（p趋势=0.002）。排除当前轮班工作者后得到了类似结果。
睡眠时间和时间安排不规律可能是CVD的新危险因素，独立于传统CVD危险因素以及睡眠数量和/或质量。
