Abstract P271: Objectively Measured Sleep Phenotypes Are Associated With Cardiovascular Health in Men and Women: Results From the Multi-Ethnic Study of Atherosclerosis Sleep Study
Authors: Makarem Nour , St-Onge Marie-Pierre , Castro-Diehl Cecilia , Redline Susan , Shea Steven , Lloyd-Jones Donald , Ning Hongyan , Aggarwal Brooke 
Published: March 2019

Introduction:
Poor sleep patterns are ubiquitous and may play a role in cardiovascular disease etiology through their influence on health behaviors and factors included in the American Heart Association Life’s Simple 7 (AHA LS7). Associations of objectively measured sleep phenotypes with meeting cardiovascular health (CVH) metrics have not been previously examined in a population-based cohort of US men and women.

Hypothesis:
We hypothesized that sleep duration and continuity, insomnia, and sleep disordered breathing (SDB) would be associated with meeting overall and individual AHA LS7 metrics and that associations would vary by sex.

Methods:
Data from 1,920 adults (mean age: 68.5 y, 54% female), in the MESA Sleep Study, which coincided with Exam 5 and included questionnaires, overnight polysomnography, and 1 wk of wrist actigraphy, were used. Participants were categorized based on their level of meeting AHA LS7 metrics (smoking, diet, physical activity, BMI, blood pressure (BP), cholesterol, and glucose) as: ideal (2 points), moderate (1 point) or poor (0 points). Metric scores were summed to create an AHA LS7 score such that scores of 0-7, 8-11, and 12-14 represented poor, moderate, and ideal CVH, respectively. Linear and logistic regression models adjusted for age, race/ethnicity, education, health insurance, and alcohol were used to examine associations of sleep with CVH and any differences by sex.

Results:
Half of the sample had poor CVH (51%), and 44% and 5% had moderate and ideal CVH, respectively. In logistic models, sleeping <6h/night was associated with 26% higher odds of poor CVH (OR (95%CI): 1.26 (1.01-1.56)). Doctor-diagnosed obstructive sleep apnea and an apnea hypoxia index ≥ 5 events/h (SDB) were associated with 79% and 96% higher odds of poor CVH (OR (95%CI): 1.79 (1.27-2.51) and 1.96 (1.56-2.45), respectively); associations did not vary by sex. Habitual snoring was associated with 44% and 60% higher odds of poor CVH in the overall sample and in women (OR (95%CI): 1.44 (1.05-1.97) and 1.60 (1.03-2.50)). In linear models, each additional hour of sleep was associated with a higher AHA LS7 score in the overall sample (β=0.09, p=0.019) and in men (β=0.13, p=0.025); while higher sleep maintenance efficiency, a measure of sleep quality, was associated with a higher AHA LS7 score in women (β=0.07, p=0.001) (
p-interaction
<0.05). When sleep patterns were examined in relation to individual CVH metrics, sleeping <6h was associated with not meeting the smoking (p=0.031), BMI (p<0.01), and BP metrics (p=0.022). Insomnia (WHI Insomnia Rating Scale score >10) was associated with not meeting the physical activity metric (p<0.01). SDB was associated with not meeting the BMI, BP and glucose metrics (p≤0.01).

Conclusions:
SDB and shorter sleep were associated with poor CVH and with not meeting BMI, BP, and glucose metrics. Disrupted sleep continuity was associated with lower CVH scores in women.