Association of sleep-related disorders with cardiovascular disease among adults in the United States: A cross-sectional study based on national health and nutrition examination survey 2005–2008
Authors: Kadier Kaisaierjiang , Qin Lian , Ainiwaer Aikeliyaer , Rehemuding Rena , Dilixiati Diliyaer , Du Yi-Ying , Maimaiti Halimulati , Ma Xiang , Ma Yi-Tong 
Published: August 2022

Background and objective

The association between sleep-related disorders and cardiovascular diseases (CVDs) remains controversial and lacks epidemiological evidence in the general population. We investigated whether sleep-related disorders are related to CVDs in a large, nationally representative, diverse sample of American adults.

Materials and methods

Data were collected from the National Health and Nutrition Examination Survey (NHANES) 2005–2008. Logistic regression was performed to explore associations of sleep-related disorders with the prevalence of total and specific CVDs. Stratified subgroup analysis was performed to exclude interactions between variables and sleep-related disorders. Non-linearity was explored using restricted cubic splines.

Results

In total, 7,850 participants aged over 20 years were included. After controlling for confounders, multivariate regression analysis showed that sleep problems were associated increases in risk of 75% for CVD (OR: 1.75; 95% CI 1.41, 2.16), 128% for congestive heart failure (CHF) (OR: 2.28; 95% CI 1.69, 3.09), 44% for coronary heart disease (CHD) (OR: 1.44; 95% CI 1.12, 1.85), 96% for angina pectoris (AP) (OR: 1.96; 95% CI 1.40, 2.74), 105% for heart attack (OR: 2.05; 95% CI 1.67, 2.53) and 78% for stroke (OR: 1.78; 95% CI 1.32, 2.40). Daytime sleepiness was associated increases in risk of 54% for CVD (OR: 1.54; 95% CI 1.25, 1.89), 73% for CHF (OR: 1.73; 95% CI 1.22, 2.46), 53% for AP (OR: 1.53; 95% CI 1.12, 2.10), 51% for heart attack (OR: 1.51; 95% CI 1.18, 1.95), and 60% for stroke (OR: 1.60; 95% CI 1.09, 2.36). Participants with insufficient sleep had a 1.42-fold higher likelihood of CVD (OR: 1.42; 95% CI 1.13, 1.78) and a 1.59-fold higher likelihood of heart attack (OR: 1.59; 95% CI 1.19, 2.13) than participants with adequate sleep. Prolonged sleep-onset latency was associated with an increased risk of CVD (OR: 1.59; 95% CI 1.17, 2.15), CHF (OR: 2.08; 95% CI 1.33, 3.23) and heart attack (OR: 1.76; 95% CI 1.29, 2.41). Short sleep-onset latency was associated with a 36% reduction in stroke risk (OR: 0.64; 95% CI 0.45, 0.90). The association of sleep problems with CVD risk was more pronounced in the group younger than 60 years (p for interaction = 0.019), and the relationship between short sleep-onset latency and total CVD differed by sex (p for interaction = 0.049). Additionally, restricted cubic splines confirmed a linear relationship between sleep-onset latency time and CVD (p for non-linearity = 0.839) and a non-linear relationship between sleep duration and CVD (p for non-linearity &lt;0.001).

Conclusion

According to a limited NHANES sample used to examine sleep-related disorders and CVD, total and specific CVDs could be associated with certain sleep-related disorders. Additionally, our study uniquely indicates that CVD risk should be considered in participants younger than 60 years with sleep problems, and shortened sleep-onset latency may be a CVD protective factor in females.