Poor Sleep Quality is Independently Associated with Cardiometabolic Risk Factors
Authors: Smith Kevin L. , Boeve Angelica R. , Somers Virend K. , Bukartyk Jan , St Louis Erik K. , Covassin Naima 
Published: June 2021

BackgroundThe prevalence of inadequate sleep in the general population is rising. While the detrimental health consequences of sleep disorders such as sleep‐disordered breathing are well established, little is known on the contributory role of perceived sleep quality on cardiometabolic risk profile. Importantly, poor sleep quality may be reported even in absence of objective findings of suboptimal sleep. We hypothesized that subjective poor sleep quality would be associated with markers of cardiometabolic risk in individuals without sleep disorders.MethodsWe compiled data from 667 research subjects (446 males, age 36.4±13.8 years) studied in the Cardiovascular/Sleep Laboratory at Mayo Clinic from 2000 to 2017. Subjects with history of sleep disorders and/or overt cardiovascular diseases, as determined from medical record or self‐report, were excluded from this study. Health status was further confirmed by physical exam. Supine systolic and diastolic blood pressure (SBP/DBP), height, weight, and waist and hip circumferences were collected. Body mass index (BMI, kg/m2) was derived from height and weight. Presence of hypertension (SBP and/or DBP ≥140/80 mmHg) and obesity (BMI ≥30 kg/m2) was recorded. Subjective sleep quality was self‐reported as either good or poor. Analysis of variance and Chi‐square tests were performed to examine differences in outcome measures according to sleep quality. Logistic regression models were run to examine the predictive value of poor sleep quality for hypertension and obesity risk.ResultsPoor subjective sleep quality was reported by 231 individuals out of 667 (34.6%). Subjects with perceived poor sleep were older (poor sleep vs good sleep: 42.3±12.9 years vs 33.2±13.3 years, p<0.0001), with greater BMI (31.4±7 kg/m2 vs 26.5±6.3 kg/m2, p<0.0001), waist (104.6±17.8 kg/m2 vs 89.7±14.8 kg/m2, p<0.0001) and hip (111.8±14.8 kg/m2 vs 102.3±11.5 kg/m2, p<0.0001) circumference than good sleepers. Compared to the latter group, SBP and DBP values were also higher in self‐evaluated poor sleepers (poor sleep vs good sleep, SBP: 128.8±15.5 mmHg vs 122.9±14.4 mmHg, p<0.0001; DBP: 74.5±10.6 mmHg vs 71.8±11.4 mmHg, p=0.012). Obesity was more prevalent in those with subjective poor sleep quality than in good sleepers (53.3% vs 19.7%, p<0.0001). Similarly, 72.5% of patients with hypertension reported poor sleep quality while only 27.5% of them were good sleepers (p<0.0001). In comparison to good sleep quality, perceived poor sleep was associated with 3.6 times greater risk of obesity (95% CI 2.5, 5.2, p<0.0001) and 3.5 times greater risk of hypertension (95% CI 1.7, 6.9, p=0.0004) after correcting for conventional covariates. Significance was retained after further adjustment for reported snoring and witnessed apneas.ConclusionsPoor perceived sleep quality is independently associated with elevated risk of high blood pressure and excess body weight in individuals without sleep disorders. These findings favor the concept that promoting adequate sleep quality, even subjectively, may benefit cardiometabolic health.Support or Funding InformationAmerican Heart Association grant 16SDG27250156; National Institutes of Health grants RO1 HL 065176 and HL 134808.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.