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By Mark DaCosta -For the first time scientists have definitively concluded that high quality sleep is a major determinant of cardiovascular health (CVH). In a paper dated October 19, 2022, the Columbia University’s Mailman School of Public Health released its findings. “Our results demonstrate that sleep is an integral component of CVH.
Nour Makarem, PhD, assistant professor of epidemiology at Columbia Mailman School of Public Health and lead author of the study said the following. “Even a CVH score that includes only sleep duration, the most widely measured aspect of sleep health and the most feasible measure to obtain in a clinic or public health setting, predicted Cardiovascular disease (CVD) incidence.”
The Professor said, “Notably, we also found that a CVH score that incorporated multiple dimensions of sleep health was also significantly associated with incident CVD. Our results highlight the importance of embracing a holistic vision of sleep health that includes sleep behaviours and highly prevalent, mild sleep problems rather than strictly focusing on sleep disorders when assessing an individual’s cardiovascular risk.”
The study found that those who slept fewer than seven hours had a higher prevalence of heart disease risk factors like obesity, type 2 diabetes and high blood pressure. Other research has also shown connections between short sleep and chronic diseases that could also hurt heart health.
David Goff, MD, PhD, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), agreed. “This study provides compelling evidence that sleep metrics are an important factor in cardiovascular health,” he said.
The American Heart Association had long established 7 guidelines for a healthy heart and general CVH. Those guidelines were: quit tobacco, eat better, get active, manage weight, manage blood pressure, control cholesterol, reduce blood sugar. Following preliminary reports from ongoing research by the Columbia University’s Mailman School of Public Health, the American Medical association (AMA), in June, added “get healthy sleep” to the guidelines. The 8 items in the revised guidelines were officially named “Life’s Essential 8.”
What does this study mean?
The research concludes that “sleep [measurements] add independent predictive value for CVD events [such as heart attacks and strokes] over and above the original 7 CVH metrics.
The study shows that inadequate high-quality sleep contributes to other unhealthy behaviours such as bad eating habits, unwillingness to exercise, unhealthy coping mechanisms such as excessive alcohol use and smoking, all of which contribute to CVD. Short sleepers also had higher prevalence of being overweight / obese, type 2 diabetes, and hypertension, suggesting that multiple unhealthy sleep dimensions may occur at the same time and potentially interact, further increasing risk for heart disease.
This study is important and different because the research firmly establishes that CVH scores that included sleep duration only as a measure of overall sleep health as well as CVH scores that included multiple dimensions of sleep health such as sleep duration, efficiency, and regularity, daytime sleepiness, and sleep disorders were both predictive of future CVD. In other words the research not only looks at how long a person sleeps but also when and how well persons sleep. And both the sleep-duration and sleep-quality predict and affect the risk of CVD.
The study recommends that, “Healthcare providers should assess their patients’ sleep patterns, discuss sleep-related problems, and educate patients about the importance of prioritising sleep to promote CVH. Furthermore, the formal integration of sleep health into CVH promotion guidance will provide [healthcare providers with] benchmarks for surveillance and ensure that sleep becomes an equal counterpart in public health policy to the attention and resources given to other lifestyle behaviours.”
While other studies are currently being undertaken, persons are advised that 7 to 9 hours of sleep is recommended. And, considering the importance of these findings, persons experiencing sleep related problems should consult a doctor.
(Co-authors of the landmark study are Marie-Pierre St-Onge and Brooke Aggarwal, Columbia University Irving Medical Center; Susan Redline, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School; Steven Shea, Columbia Mailman School of Public Health and Columbia University Irving Medical Center; Donald Lloyd-Jones and Hongyan Ning, Feinberg School of Medicine, Northwestern University).