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Sleep Duration and Cardiovascular Health

Senior woman sleeping on bed at night.

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
 
 

 

Sleep & Cardiovascular Diseases | Why Does Sleep Affect Cardiovascular Health?

 

Overview

According to the National Sleep Foundation, adults should sleep 7 to 9 hours daily.[1] In the last few decades, sleep duration has reduced due to various reasons in business and social life. There are many reasons for shorter sleep time, such as shift work syndrome, insomnia, and behavior-induced sleep deprivation. 

In addition, some social and psychological factors can lead to longer sleep times than usual. In both cases, abnormal sleep duration can increase the risk of cardiovascular diseases, the leading cause of global mortality and morbidity, and the severity of existing conditions. 

Across the world, financial resources are allocated to diagnose and treat cardiovascular diseases. In this context, the value of every step taken to increase cardiovascular health can be better understood.

 

Sleep & Cardiovascular Diseases

1) Hypertension

Sleeping less or more than usual is associated with an increased prevalence of hypertension in the general population.[2] 

According to a large study, the risk of developing hypertension is 1.7 times higher for those who sleep less than 6 hours and 1.3 times for those who sleep more than 9 hours, compared to those who sleep 8 hours a day.[3] 

In another study, the lowest risk of hypertension was seen in those who sleep 7 to 7.9 hours daily.[4] In addition, available evidence shows that short sleep significantly increases the risk of hypertension than long sleep.[5]

Another study found that short sleep increased the risk of developing hypertension in adults younger than 60 but not in older people (≥60).[6] 

Also, the relationship between short sleep and hypertension is more pronounced in women.[7]

 

2) Coronary Heart Disease

Another major health problem associated with abnormal sleep time is coronary heart disease, the primary cause of death globally. The risk of cardiovascular events rises to 1.5 for short and 1.4 for long sleepers.[8] 

Shortened sleep duration is a precursor to coronary artery disease and the clinical changes that precede it. It has been shown that short sleep is associated with both carotid intima thickening and coronary artery calcification.[9][10]

 

3) Cerebrovascular Diseases

Another important cause of cardiovascular death is cerebrovascular disease. 

Researchers speculate that there is a U-shaped relationship between sleep and cerebrovascular disease. On the other hand, in contrast to coronary artery disease and hypertension, prolonged sleep has been shown to increase the risk of cerebrovascular disease more significantly than shortened sleep.[11] 

A recent study of almost 80,000 people observed that prolonged sleep increased the risk of total and ischemic stroke, and shortened sleep increased the risk of intracranial hemorrhage.[12] Many studies show that prolonged sleep also increases the mortality of stroke.[13]

 

4) Erectile Dysfunction

Erectile dysfunction is a significant health problem that concerns many people worldwide. Although different reasons lead to erectile dysfunction, the cause is vascular insufficiency in many patients. 

In this respect, it is accepted as a precursor of other cardiovascular diseases.[14] Although the cause-and-effect relationship cannot be established definitively, short sleep duration is considered an independent risk factor for some erectile dysfunction subtypes.[15] 

As with other cardiovascular diseases, potential mechanisms that associate short sleep with erectile dysfunction are inflammation, endothelial dysfunction, and other metabolic/hormonal changes.

SCOFA Sleep Duration and Cardiovascular Health 2

 

Why Does Sleep Affect Cardiovascular Health?

Numerous physiological processes maintain body homeostasis, many of which have a 24-hour oscillation. The human body’s fundamental component of the 24-hour physiological cycle is sleep. Therefore, disruption of the sleep cycle affects all systems. 

Short or prolonged sleep suppresses the nocturnal blood pressure decrease, which can lead to many cardiovascular diseases, especially hypertension.[16][17] Shortened sleep increases the dominance of the sympathetic system, which causes blood pressure to rise. 

Inflammation and endothelial dysfunction are common basic mechanisms of many chronic diseases, and it’s known that these two processes are negatively affected by shortened sleep.[18][19] 

Another possible mechanism is glucose metabolism and insulin resistance, which are disrupted by shortened sleep.[20] This physiological effect can increase the risk of obesity and diabetes mellitus. Another metabolic disorder that comes with insufficient sleep is decreased testosterone secretion in men.[21]

Finally, there is evidence that sleep deprivation is associated with a pro-thrombotic state, an important cardiovascular risk factor.[22] 

 

Conclusion

Today, it is known that sleep deficiency or disorder is associated with many chronic diseases. The quality of life decreases and the use of health resources increases in people with sleep deprivation. 

Sleeping shorter or longer than adequate has several adverse long-term effects. One of the most important of these effects is increased cardiovascular risk. 

Evaluation of sleep duration and quality should be included in managing cardiovascular diseases. According to a study examining all-cause mortality and sleep duration, the best life expectancy was achieved with 7 to 8 hours of sleep per day.[23] 

Key Takeaways: 

  • Ideal sleep time for adults is 7-9 hours per day
  • Many people have a shorter or longer sleep time than recommended
  • Abnormal sleep time has a relationship with many cardiovascular diseases 
  • Shorter and longer sleep times increase the risk of hypertension, coronary heart disease, and stroke
  • It’s crucial to have an appropriate sleep duration to support cardiovascular health

 

References:

  1. Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health,1(1), 40-43. https://doi.org/10.1016/j.sleh.2014.12.010
  2. Han, B., Chen, W. Z., Li, Y. C., Chen, J., & Zeng, Z. Q. (2020). Sleep and hypertension. Sleep Breath,24(1), 351-356. https://doi.org/10.1007/s11325-019-01907-2
  3. 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
  4. Gottlieb, D. J., Redline, S., Nieto, F. J., Baldwin, C. M., Newman, A. B., Resnick, H. E., & Punjabi, N. M. (2006). Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep,29(8), 1009-1014. https://doi.org/10.1093/sleep/29.8.1009
  5. Guo, X., Zheng, L., Wang, J., Zhang, X., Zhang, X., Li, J., & Sun, Y. (2013). Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med,14(4), 324-332. https://doi.org/10.1016/j.sleep.2012.12.001
  6. Gangwisch, J. E., Heymsfield, S. B., Boden-Albala, B., Buijs, R. M., Kreier, F., Pickering, T. G., Rundle, A. G., Zammit, G. K., & Malaspina, D. (2006). Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension,47(5), 833-839. https://doi.org/10.1161/01.HYP.0000217362.34748.e0
  7. Stranges, S., Dorn, J. M., Cappuccio, F. P., Donahue, R. P., Rafalson, L. B., Hovey, K. M., Freudenheim, J. L., Kandala, N. B., Miller, M. A., & Trevisan, M. (2010). A population-based study of reduced sleep duration and hypertension: the strongest association may be in premenopausal women. J Hypertens,28(5), 896-902. https://doi.org/10.1097/HJH.0b013e328335d076
  8. 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
  9. Sands, M. R., Lauderdale, D. S., Liu, K., Knutson, K. L., Matthews, K. A., Eaton, C. B., Linkletter, C. D., & Loucks, E. B. (2012). Short sleep duration is associated with carotid intima-media thickness among men in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Stroke,43(11), 2858-2864. https://doi.org/10.1161/STROKEAHA.112.660332
  10. King, C. R., Knutson, K. L., Rathouz, P. J., Sidney, S., Liu, K., & Lauderdale, D. S. (2008). Short sleep duration and incident coronary artery calcification. JAMA,300(24), 2859-2866. https://doi.org/10.1001/jama.2008.867
  11. Ge, B., & Guo, X. (2015). Short and long sleep durations are both associated with increased risk of stroke: a meta-analysis of observational studies. Int J Stroke,10(2), 177-184. https://doi.org/10.1111/ijs.12398
  12. Titova, O. E., Michaelsson, K., & Larsson, S. C. (2020). Sleep Duration and Stroke: Prospective Cohort Study and Mendelian Randomization Analysis. Stroke,51(11), 3279-3285. https://doi.org/10.1161/STROKEAHA.120.029902
  13. McDermott, M., Brown, D. L., & Chervin, R. D. (2018). Sleep disorders and the risk of stroke. Expert Rev Neurother,18(7), 523-531. https://doi.org/10.1080/14737175.2018.1489239
  14. Yamada, T., Hara, K., Umematsu, H., Suzuki, R., & Kadowaki, T. (2012). Erectile dysfunction and cardiovascular events in diabetic men: a meta-analysis of observational studies. PLoS One,7(9), e43673. https://doi.org/10.1371/journal.pone.0043673
  15. Zhang, F., Xiong, Y., Qin, F., & Yuan, J. (2022). Short Sleep Duration and Erectile Dysfunction: A Review of the Literature. Nat Sci Sleep,14, 1945-1961. https://doi.org/10.2147/NSS.S375571
  16. Friedman, O., Shukla, Y., & Logan, A. G. (2009). Relationship between self-reported sleep duration and changes in circadian blood pressure. Am J Hypertens,22(11), 1205-1211. https://doi.org/10.1038/ajh.2009.165
  17. Yano, Y., & Kario, K. (2012). Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res,35(7), 695-701. https://doi.org/10.1038/hr.2012.26
  18. 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
  19. 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
  20. 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
  21. Carter, J. R., Durocher, J. J., Larson, R. A., DellaValla, J. P., & Yang, H. (2012). Sympathetic neural responses to 24-hour sleep deprivation in humans: sex differences. Am J Physiol Heart Circ Physiol,302(10), H1991-1997. https://doi.org/10.1152/ajpheart.01132.2011
  22. Liu, H., Wang, G., Luan, G., & Liu, Q. (2009). Effects of sleep and sleep deprivation on blood cell count and hemostasis parameters in healthy humans. J Thromb Thrombolysis,28(1), 46-49. https://doi.org/10.1007/s11239-008-0240-z
  23. Cappuccio, F. P., D’Elia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep,33(5), 585-592. https://doi.org/10.1093/sleep/33.5.585
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