AHA Issues Statement on Sleep Health Related to Cardiometabolic Health

The American Heart Association (AHA) has published a scientific statement on multidimensional sleep health associated with cardiometabolic health (CMH) in adults, as reported in Circulation: Cardiovascular Quality and Outcomes.

The AHA added sleep duration as an eighth metric of CMH as part of Life’s Essential 8 in 2022. The components of multidimensional sleep health include the dimensions of regularity/rhythmicity, satisfaction/quality, alertness/sleepiness, timing, efficiency, duration, disturbed sleep, and sleep architecture.

Multidimensional sleep health refers to a pattern of sleep-wakefulness that is adapted to individual, social, and environmental demands and promotes physical and mental well-being, according to the AHA writing group. Assessment of sleep health includes self-report and objective methods such as in-laboratory polysomnography. Newer strategies include portable wearable devices with electroencephalographic sensors, and retrospective self-reported sleep assessments also can be useful.

Health disparities frequently have an adverse effect on sleep health. Individuals in historically underrepresented racial or ethnic groups have an increased likelihood of short sleep duration, worse sleep continuity, less satisfaction with sleep, later and more irregular sleep, and sleepiness vs non-Hispanic White persons. Disparities also occur based on socioeconomic position.

Strong evidence exists for an association between short (<7 hours) or long (>9 hours) sleep with obesity, hypertension, cardiovascular disease (CVD), coronary heart disease, type 2 diabetes, and stroke.

Multiple meta-analyses have found associations between short sleep and metabolic syndrome, atrial fibrillation, stroke, and nondipping blood pressure, and for long sleep and metabolic syndrome, arterial stiffness, stroke, and all-cause, stroke, or CVD mortality. Associations between sleep continuity with cardiovascular health outcomes have been reported for atrial fibrillation and myocardial infarction.

Evidence is limited for the relationship between inappropriate timing of sleep and CVD risk. Some research has shown that a bedtime of midnight or later is associated with increased odds of general and abdominal obesity and incident myocardial infarction. Daily variation in sleep timing has been associated with a higher risk of CVD, hypertension, inflammation, obesity, and nondipping blood pressure. A significant association has been found for excessive daytime sleepiness and CVD, coronary heart disease, stroke, and all-cause or CVD mortality.

Future research on the topic should include population studies to investigate associations of multidimensional sleep health with CMH, noted the writing group. In addition, CMH as an outcome related to sleep would be enhanced by evaluations of immunologic responses, behavioral and cognitive health, emotional well-being, and cardiovascular fitness, according to the group. The authors also noted that although the statement is aimed for adults, the same sleep dimensions are relevant to youth and should be considered in younger age groups.

“We urge the medical and scientific communities to consider evaluating multiple facets of sleep health (in addition to sleep disorders), such as sleep satisfaction, continuity, timing, regularity, and architecture, as well as daytime alertness, sleepiness, and fatigue, across the life span when evaluating CMH,” the writing group wrote.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor