Document Type : Original Article(s)
1 MD Researcher, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Researcher, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 MD Researcher, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Recent studies examining the association between sleep duration and cardiovascular disease (CVD) showed inconsistent results. The aim of our study was to evaluate the association between self-reported night sleep duration and ischemic changes in electrocardiography (ECG).METHODS: We conducted this cross-sectional study on 3513 participants from Iranian middle-aged population as a part of Isfahan Healthy Heart Program (IHHP), Isfahan, Iran. Sleep duration was obtained by questioning participants. The frequency of electrocardiographic ischemic changes was calculated using ECG Minnesota coding system.RESULTS: Short sleep duration was associated with increased frequency of electrocardiographic ischemic changes. In a fully adjusted multiple logistic regression analysis, the odds ratio (OR) for short sleep duration less than 5 hours per night was 1.501 [95% confidence interval (CI) for OR: 1.085-2.076] compared to 8 hours of sleep. After stratifying the study population into sex groups, the association remained significant only in women. The OR for short sleep less than 5 hours per night was 1.565 (95% CI for OR: 1.052-2.329) and 1.455 (95% CI for OR: 0.833-2.539) in women and men, respectively. There was no association between long sleep duration and electrocardiographic ischemic changes in men and women.CONCLUSION: We concluded that there is a positive association between short sleep duration and frequency of electrocardiographic ischemic changes in middle-aged women. This association suggests that short sleep duration may increase the risk of ischemic heart disease (IHD) in women, and this need to be evaluated in further studies.
- Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. Int J Cardiol 2013; 168(2): 934-45.
- Kronholm E, Laatikainen T, Peltonen M, Sippola R, Partonen T. Self-reported sleep duration, all-cause mortality, cardiovascular mortality and morbidity in Finland. Sleep Med 2011; 12(3): 215-21.
- Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep duration and risk of type 2 diabetes: A meta-analysis of prospective studies. Diabetes Care 2015; 38(3): 529-37.
- Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of usual sleep duration with hypertension: The Sleep Heart Health Study. Sleep 2006; 29(8): 1009-14.
- Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: A meta-analysis of prospective studies. Sleep Med 2014; 15(12): 1456-62.
- Najafian J, Toghianifar N, Mohammadifard N, Nouri F. Association between sleep duration and metabolic syndrome in a population-based study: Isfahan Healthy Heart Program. J Res Med Sci 2011; 16(6): 801-6.
- Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: The MORGEN study. Sleep 2011; 34(11): 1487-92.
- Meisinger C, Heier M, Lowel H, Schneider A, Doring A. Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: The MONICA/KORA Augsburg cohort study. Sleep 2007; 30(9): 1121-7.
- Qureshi AI, Giles WH, Croft JB, Bliwise DL. Habitual sleep patterns and risk for stroke and coronary heart disease: A 10-year follow-up from NHANES I. Neurology 1997; 48(4): 904-11.
- Suzuki E, Yorifuji T, Ueshima K, Takao S, Sugiyama M, Ohta T, et al. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: A population-based cohort study. Prev Med 2009; 49(2-3): 135-41.
- Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: Results from the National Health Interview Survey. Sleep 2010; 33(8): 1037-42.
- Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med 2003; 163(2): 205-9.
- Holliday EG, Magee CA, Kritharides L, Banks E, Attia J. Short sleep duration is associated with risk of future diabetes but not cardiovascular disease: A prospective study and meta-analysis. PLoS One 2013; 8(11): e82305.
- Chandola T, Ferrie JE, Perski A, Akbaraly T, Marmot MG. The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: A prospective study from the Whitehall II cohort. Sleep 2010; 33(6): 739-44.
- Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: A 12-year follow-up study of a middle-aged Swedish population. J Intern Med 2002; 251(3): 207-16.
- Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, et al. Isfahan Healthy Heart Programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
- Prineas RJ, Crow RS, Zhang ZM. The Minnesota code manual of electrocardiographic findings. Berlin, London: Springer Science & Business Media; 2009.
- Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, et al. A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 1997; 29(6 Suppl): S1-205.
- Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109(3): 433-8.
- Hirshkowitz M, Whiton K, Albert SM, Alessi C,
- Bruni O, DonCarlos L, et al. National Sleep Foundation's sleep time duration recommendations: Methodology and results summary. Sleep Health 2015; 1(1): 40-3.
- Eguchi K, Pickering TG, Schwartz JE, Hoshide S, Ishikawa J, Ishikawa S, et al. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med 2008; 168(20): 2225-31.
- Grandner MA, Jackson NJ, Pak VM, Gehrman PR. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res 2012; 21(4): 427-33.
- King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS. Short sleep duration and incident coronary artery calcification. JAMA 2008; 300(24): 2859-66.
- Hamazaki Y, Morikawa Y, Nakamura K, Sakurai M, Miura K, Ishizaki M, et al. The effects of sleep duration on the incidence of cardiovascular events among middle-aged male workers in Japan. Scand J Work Environ Health 2011; 37(5): 411-7.
- Aggarwal S, Loomba RS, Arora RR, Molnar J. Associations between sleep duration and prevalence of cardiovascular events. Clin Cardiol 2013; 36(11): 671-6.
- 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(12): 1484-92.
- Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1(3): e62.
- Spiegel K, Leproult R, L'hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 2004; 89(11): 5762-71.
- Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, et al. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985) 2005; 98(6): 2024-32.
- Lusardi P, Mugellini A, Preti P, Zoppi A, Derosa G, Fogari R. Effects of a restricted sleep regimen on ambulatory blood pressure monitoring in normotensive subjects. Am J Hypertens 1996; 9(5): 503-5.
- Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep 1997; 20(10): 865-70.
- Copinschi G. Metabolic and endocrine effects of sleep deprivation. Essent Psychopharmacol 2005; 6(6): 341-7.
- Aldabal L, Bahammam AS. Metabolic, endocrine, and immune consequences of sleep deprivation. Open Respir Med J 2011; 5: 31-43.
- Irwin MR, Carrillo C, Olmstead R. Sleep loss activates cellular markers of inflammation: Sex differences. Brain Behav Immun 2010; 24(1): 54-7.
- Stranges S, Dorn JM, Shipley MJ, Kandala NB, Trevisan M, Miller MA, et al. Correlates of short and long sleep duration: A cross-cultural comparison between the United Kingdom and the United States: The Whitehall II Study and the Western New York Health Study. Am J Epidemiol 2008; 168(12): 1353-64.
- Youngstedt SD, Kripke DF. Long sleep and mortality: Rationale for sleep restriction. Sleep Med Rev 2004; 8(3): 159-74.
- Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB. Correlates of long sleep duration. Sleep 2006; 29(7): 881-9.
- Ikehara S, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: The JACC study. Sleep 2009; 32(3): 295-301.
- Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: A Society for Women's Health Research Report. J Womens Health (Larchmt) 2014; 23(7): 553-62.
- Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med 2006; 12(6): 383-9.
- Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J 2010; 18(12): 598-602.
- Tan YY, Gast GC, van der Schouw YT. Gender
- differences in risk factors for coronary heart disease. Maturitas 2010; 65(2): 149-60.
- Cappuccio FP, Stranges S, Kandala NB, Miller MA, Taggart FM, Kumari M, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: The Whitehall II Study. Hypertension 2007; 50(4): 693-700.
- Wang H, Zee P, Reid K, Chervin RD, Patwari PP, Wang B, et al. Gender-specific association of sleep duration with blood pressure in rural Chinese adults. Sleep Med 2011; 12(7): 693-9.
- Zuo H, Wang J, Lin Y, Deng L, Su J, Zhang J. Gender-specific associations of sleep duration with uncontrolled blood pressure in middle-aged patients. Clin Exp Hypertens 2016; 38(2): 125-30.
- Hauri PJ, Wisbey J. Wrist actigraphy in insomnia. Sleep 1992; 15(4): 293-301.
- Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999; 8(3): 175-83.
- Signal TL, Gale J, Gander PH. Sleep measurement in flight crew: Comparing actigraphic and subjective estimates to polysomnography. Aviat Space Environ Med 2005; 76(11): 1058-63.