Short Sleep Duration and Snoring Linked to Heart Failure

Short Sleep Time and Heart Failure | Snoring and Heart Failure | What’s the Takeaway?

Overview

Heart failure is the inability of the heart to supply the organs with oxygen and blood, the fluid of life, which are vital for survival. 

Heart failure was accepted as an emerging epidemic in 1997.^[1] According to the most recent data, there are 6 million heart failure patients in the United States, corresponding to 1.8 percent of the total population.^[2]

Once heart failure is started, it’s impossible to reverse the process and cure it completely. Therefore, recognizing heart failure and its associated risk factors is essential to prevent the disease. 

Many genetic, structural, and environmental factors are associated with heart failure. This article will focus on the relationship between short sleep duration and snoring with heart failure.

Short Sleep Time and Heart Failure

Do we sleep enough? We know that about 46 percent of Americans sleep less than what’s ideal.^[3] After learning what shortened sleep can do to our hearts, you will think once again.

Today, we know that sleep is not a one-dimensional state of rest for our body. On the contrary, sleep is one of the most critical components of both physical and mental metabolism, with features such as duration, quality, and depth.

Sleep duration has been proven to be closely related to cardiovascular health. Heart failure has many risk factors. Shortened sleep contributes negatively to heart failure by increasing the likelihood of these risk factors or worsening existing conditions.

1) Coronary Heart Disease

Coronary artery disease (CAD) is the most important of these medical conditions associated with shortened sleep duration. The risk of cardiovascular events rises to 1.5 for short sleepers compared to persons with normal sleep time.^[4] Coronary artery disease is the cause of more than half of heart failures in the general population under 75.^[5]

The mechanism underlying the relationship between coronary artery disease and heart failure is not very complex. Our heart muscle, like all other living tissues and cells, needs oxygen and organic energy sources to maintain its functions. With coronary artery disease, the oxygen level delivered to the heart muscle decreases, making the heart muscle unable to function over time. 

The situation is more complicated when we examine the relationship between shortened sleep and coronary artery disease. With shortened sleep, the inflammation process is activated in the body, and autonomic and endothelial dysfunction occurs. Defects in these three essential mechanisms can lead to critical diseases such as coronary artery disease.

2) Hypertension

Another disease that links short sleep to heart failure is hypertension. The risk of hypertension is minimal in those who sleep for a normal period, and it is higher in shortened sleep than in prolonged sleep. 

The risk of developing hypertension increased to 1.7 for those who sleep less than 6 hours compared to those who sleep 8 hours a day.^[6] This relationship is more pronounced in individuals younger than 60 and women.^[3]

Hypertension, or high blood pressure, is a significant risk factor for heart failure. It can lead to the gradual thickening and stiffening of the heart muscle, making it difficult for the heart to pump blood effectively. 

According to recent statistics, hypertension is estimated to affect about half of the adults in the United States.^[7] Hypertension and coronary disease are the predominant causes of heart failure, accounting for over 80 percent of all clinical events.^[8,9]

Short sleep negatively affects the processes of inflammation and endothelial dysfunction, which are the common mechanisms of many chronic diseases.^[10,11] 

3) Glucose Metabolism Disorder/ Insulin Resistance

Another problem caused by short sleep is glucose metabolism disorder and insulin resistance.^[12] This finding can result in weight gain, obesity, and diabetes mellitus in people with chronically short sleep duration. Ultimately, short sleep duration increases the risk of heart failure through all these various pathways.

Snoring and Heart Failure

Snoring is one of the most common symptoms of obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB). 

It is well known that OSA patients have an increased risk of heart failure and many other cardiovascular diseases.^[13] On the other hand, there are conflicting results about whether isolated snoring (without OSA or SDB) increases the risk of heart failure. 

Some studies say that isolated snoring increases the risk of heart failure, while others say it increases the risk when combined with other symptoms, such as daytime sleepiness.^[14,15]

In a study published in 2023 that included 93,000 adults, the relationship between sleep duration, snoring, and heart failure risk was investigated in detail.^[16] In this study, approximately nine years of patient follow-up was made, and the risk of heart failure was found as 1.29 for those who slept 6-6.9 hours and 1.24 for those who slept less than 6 hours compared to those who slept 7-7.9 hours. 

These results mean that less than 7 hours of sleep increases the risk of heart failure by approximately 25 percent. 

Similarly, snoring has been shown to cause a 20-30 percent increase in the risk of heart failure. It has been observed that diabetes has a role in the relationship between both shortened sleep and snoring and heart failure, and hypertension, especially in the relationship between snoring and heart failure.

The mechanism underlying the increased risk of heart failure with snoring has many components. These are inflammation, atherosclerosis, endothelial dysfunction, hypercoagulability, metabolic dysregulation, hemodynamic changes, left atrial enlargement, and sympathetic activation.

What’s the Takeaway?

Heart failure is a significant health problem that affects millions of people worldwide. Healthy sleep directly supports heart health and many different organs and systems. 

Shortened sleep duration and impaired breathing during sleep increase the risk of heart disease. Our current knowledge states that this effect occurs through different pathological pathways and that hypertension, diabetes mellitus, and obesity are critical. 

It’s important to note that these are preventable and manageable conditions. By making lifestyle changes such as maintaining a quality sleep in terms of duration and content, a healthy diet, engaging in regular physical activity, and managing stress, individuals can reduce their risk of developing these conditions and, subsequently, lower their risk of heart failure.

In this context, early detection and treatment of sleep disorders are critical for heart health. A healthy sleep supports our entire body, including our heart, which is at the center of all our systems.

Key Points:

• Heart failure is a significant health problem that affects 6 million people in the United States.
• Heart failure is an irreversible, progressive disease.
• Reducing the risk of heart failure is possible by avoiding risk factors.
• Short sleep time and snoring increase the risk of heart failure through risk factors such as hypertension, coronary artery disease, obesity, and diabetes mellitus.
• Forty-six percent of Americans sleep less than enough.
• Short sleep increases the risk of heart failure by approximately 25 percent.
• Snoring increases the risk of heart failure by approximately 20-30 percent.

References:

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2. Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S. V., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T., . . . Stroke Statistics, S. (2021). Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation, 143(8), e254-e743. https://doi.org/10.1161/CIR.0000000000000950
3. Covassin, N., & Singh, P. (2016). Sleep Duration and Cardiovascular Disease Risk: Epidemiologic and Experimental Evidence. Sleep Med Clin, 11(1), 81-89. https://doi.org/10.1016/j.jsmc.2015.10.007
4. Cappuccio, F. P., Cooper, D., D’Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J, 32(12), 1484-1492. https://doi.org/10.1093/eurheartj/ehr007
5. Fox, K. F., Cowie, M. R., Wood, D. A., Coats, A. J., Gibbs, J. S., Underwood, S. R., Turner, R. M., Poole- Wilson, P. A., Davies, S. W., & Sutton, G. C. (2001). Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J, 22(3), 228-236. https://doi.org/10.1053/euhj.2000.2289
6. Fang, J., Wheaton, A. G., Keenan, N. L., Greenlund, K. J., Perry, G. S., & Croft, J. B. (2012). Association of sleep duration and hypertension among US adults varies by age and sex. Am J Hypertens, 25(3), 335- 341. https://doi.org/10.1038/ajh.2011.201
7. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline— NHANES 2015–2018. Atlanta, GA: US Department of Health and Human Services; 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
8. Kannel, W. B., & Belanger, A. J. (1991). Epidemiology of heart failure. American Heart Journal, 121(3, Part 1), 951-957. https://doi.org/https://doi.org/10.1016/0002-8703(91)90225-7
9. Roger, V. L. (2021). Epidemiology of Heart Failure: A Contemporary Perspective. Circ Res, 128(10), 1421-1434. https://doi.org/10.1161/CIRCRESAHA.121.318172
10. Irwin, M. R., Olmstead, R., & Carroll, J. E. (2016). Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biol Psychiatry, 80(1), 40-52. https://doi.org/10.1016/j.biopsych.2015.05.014
11. Cherubini, J. M., Cheng, J. L., Williams, J. S., & MacDonald, M. J. (2021). Sleep deprivation and endothelial function: reconciling seminal evidence with recent perspectives. Am J Physiol Heart Circ Physiol, 320(1), H29-H35. https://doi.org/10.1152/ajpheart.00607.2020
12. Antza, C., Kostopoulos, G., Mostafa, S., Nirantharakumar, K., & Tahrani, A. (2021). The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol, 252(2), 125-141. https://doi.org/10.1530/JOE-21-0155
13. Holt, A., Bjerre, J., Zareini, B., Koch, H., Tonnesen, P., Gislason, G. H., Nielsen, O. W., Schou, M., & Lamberts, M. (2018). Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy. J Am Heart Assoc, 7(13). https://doi.org/10.1161/JAHA.118.008684
14. Koskenvuo, M., Partinen, M., Kaprio, J., Vuorinen, H., Telakivi, T., Kajaste, S., Salmi, T., & Heikkila, K. (1994). Snoring and cardiovascular risk factors. Ann Med, 26(5), 371-376. https://doi.org/10.3109/07853899409148353
15. Ljunggren, M., Byberg, L., Theorell-Haglow, J., Lindahl, B., Michaelsson, K., & Lindberg, E. (2016). Increased risk of heart failure in women with symptoms of sleep-disordered breathing. Sleep Med, 17, 32-37. https://doi.org/10.1016/j.sleep.2015.09.018
16. Zhuang, S., Huang, S., Huang, Z., Zhang, S., Al-Shaar, L., Chen, S., Wu, S., & Gao, X. (2023). Prospective study of sleep duration, snoring and risk of heart failure. Heart. https://doi.org/10.1136/heartjnl-2022- 321799