CMHC Pulse Blog

Individual genetic predisposition and lifestyle choices – from dietary habits to physical activity levels – contribute to the development of cardiometabolic disease making health behaviors a key intervention target for clinicians to modify patient risk. On an individual level, lifestyle choices significantly impact the progression of metabolic dysfunction. Often overlooked yet with a known impact on numerous cardiometabolic disease risk factors is sleep, a key health behavior that many patients struggle with. Emerging studies are beginning to clarify the underlying mechanisms between sleep and cardiometabolic risk factors, drawing much-needed attention to what has been deemed “the forgotten pillar of health”.

The Implications of Disordered Sleep

Sleep-disordered breathing, insomnia, as well as obstructive sleep apnea among other sleep disorders have been classified as risk factors for a host of cardiometabolic conditions including obesity, hypertension, stroke, coronary heart disease, heart failure, and more. Such conditions can directly and indirectly impact a large set of cardiovascular disease markers and health risk factors. As such, the health implications of disordered, long, or short sleep on cardiometabolic health develop as part of a long-term process.

Insufficient sleep has been found to contribute to poor quality dietary choices, weight gain, the development of obesity, as well as related cardiometabolic conditions. Sleep restriction can lead to impaired glucose tolerance and has the potential to increase fasting insulin levels, HbA1C, and fasting blood glucose levels, all of which are markers of type II diabetes. As a result, hypertension and diabetes risk is significantly heightened in individuals with sleep disorders and those who sleep for short periods of time – this particularly affects younger adults.

Both the duration and quality of sleep are factors that have been associated with elevated blood pressure; self-reported shortened sleep durations or subjectively assessed poor sleep quality have been linked to higher blood pressure levels and a higher prevalence of hypertension. On the other hand, long sleep durations have also been linked to increases in the risk for coronary heart disease, however, both short and long sleep durations have been associated with stroke. Furthermore, acute sleep restriction can cause elevations in pro-inflammatory cytokines which further compound cardiometabolic dysfunctions.

Overall, the effects of sleep disorders and disordered sleeping patterns on metabolism function, decision-making, and key disease markers such as inflammatory levels along with other underlying pathways exacerbate many of the contributing factors of cardiometabolic disease.

Examining the Relationship between Sleep and Cardiometabolic Health

As part of a previous study, a team of researchers conducted an extensive critical analysis of literature concerning the relationship of non-optimal sleep duration, sleep disorders, and cardiometabolic health. According to the authors, there were population-level trends and meta-analyses that strongly supported the importance of sleep, regardless of other covariates included, on cardiometabolic health. These associations have been further strengthened by recent studies that describe the physiologic and behavioral pathways in which sleep disorders influence cardiometabolic health, enhancing risk factors and furthering the development of cardiovascular disease.

Additional research has proven that sleep-related variations in decision-making and lifestyle behaviors have a direct effect on adiposity, insulin and glucose control, blood pressure, and inflammation. As such, studies have shown that poor sleep can lead to myocardial infarction, stroke, and heightened CVD all-cause mortality over time.

Key Takeaway

Sleep has been deemed one of the behavioral risk factors that can be easily reversible with lifestyle interventions and is likely to soon become added to the list of important target behaviors for cardiometabolic health.  It is essential that clinicians recognize the impact of sleep disorders on cardiometabolic health and know how to address these conditions as part of comprehensive lifestyle modifications for disease prevention and treatment. Early intervention is important, according to a recent commentary published by the American Heart Association: “Chronic exposure to sleep disorders, just like chronic exposure to poor diet, excessive alcohol use, inactive lifestyle, and other health risk behaviors, may compound CVD risk over time.”


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