Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women

Abstract

Introduction: Midlife, which encompasses the menopause transition in women, can be a time of disrupted sleep and accelerated atherosclerosis accumulation. Short or poor sleep quality has been associated with cardiovascular disease (CVD) risk; few studies have investigated relations among midlife women. We tested whether shorter actigraphy sleep time or poorer subjective sleep quality was associated with carotid atherosclerosis among midlife women.

Aims and methods: Two hundred fifty-six peri- and postmenopausal women aged 40-60 years completed 3 days of wrist actigraphy, hot flash monitoring, questionnaires (Pittsburgh Sleep Quality Index [PSQI], Berlin), a blood draw, and carotid ultrasound [intima media thickness (IMT), plaque]. Associations of objective (actigraphy) and subjective (PSQI) sleep with IMT/plaque were tested in regression models (covariates: age, race, education, body mass index, blood pressure, lipids, insulin resistance, medications, snoring, depressive symptoms, sleep hot flashes, and estradiol).

Results: Shorter objective sleep time was associated with higher odds of carotid plaque (for each hour shorter sleep, plaque score ≥ 2, odds ratio (OR) [95% confidence interval, CI] = 1.58 [1.11-2.27], p = .01; plaque score = 1, OR [95% CI] = 0.95 [0.68-1.32], p = .75, vs. no plaque, multivariable). Poorer subjective sleep quality was associated with higher mean IMT [β, b (standard error, SE) = 0.004 (0.002), p = .03], maximal IMT [b (SE) = 0.009 (0.003), p = .005], and plaque [plaque score ≥ 2, OR (95% CI) = 1.23 (1.09-1.40), p = .001; score = 1, OR (95% CI) = 1.06 (0.93-1.21), p = .37, vs. no plaque] in multivariable models. Findings persisted additionally adjusting for sleep hot flashes and estradiol.

Conclusions: Shorter actigraphy-assessed sleep time and poorer subjective sleep quality were associated with increased carotid atherosclerosis among midlife women. Associations persisted adjusting for CVD risk factors, hot flashes, and estradiol.

Keywords: cardiovascular disease.; intima media thickness; menopause; sleep.

Figure 1

Percentage of women with degrees of carotid plaque by total sleep time. **p < .01, relative to >420 min, multivariable. Note: Y axis indicates percentage of women in each plaque index (PI) category, stratified by total sleep time.

Figure 2

Mean IMT by total sleep time. *p < .05, relative to 361–420 min. Adjusted means, adjusted for age, race, education, BMI, SBP, DBP, HDL, LDL trig, HOMA, medication use (blood pressure-lowering, lipid-lowering, diabetes), snoring, and CESD.

Figure 3

Percentage of women with levels of carotid plaque by PSQI score. ^† p < .10, *p < .05, **p < .01, relative to ≤3, multivariable. Note: Y axis indicates percentage of women in each plaque index (PI) category, stratified by PSQI score.