Association of sleep characteristics with cardiovascular health among women and differences by race/ethnicity and menopausal status: findings from the American Heart Association Go Red for Women Strategically Focused Research Network

Abstract

Background and objective: Sleep is an emerging risk factor for cardiovascular disease (CVD) that is not currently included as a cardiovascular health (CVH) metric in the American Heart Association's Life's Simple 7 (AHA LS7). Our objective was to evaluate the association of sleep with CVH in women and examine differences by menopausal status and race/ethnicity.

Methods: Baseline data from the Columbia University AHA Go Red for Women Strategically Focused Research Network were examined. Sleep habits were self-reported using validated questionnaires. A CVH score was computed using AHA LS7 criteria for smoking, diet, physical activity, BMI, blood pressure(BP), total cholesterol, and fasting glucose. Women received a score of 2 (ideal), 1 (intermediate), or 0 (poor) based on their level of meeting each AHA LS7 metric. Multivariable-adjusted regression models were used to evaluate associations of sleep with meeting overall and individual CVH metrics.

Results: The analytical sample consisted of n = 507 women (62% minority/Hispanic, mean age:37 y). Participants with adequate sleep duration (≥7 h), good sleep quality, no insomnia nor snoring, and low risk for OSA were more likely to meet >4 of the AHA LS7 metrics (P < .01). Poorer sleep quality (β = -0.08, P = .002), higher insomnia severity (β = -0.05, P = .002), snoring (β = -0.77, P = .0001), and higher risk for OSA (β = -1.63, P < .0001) were associated with poorer CVH. Insomnia, snoring, and high OSA risk were associated with 69% to >300% higher odds of having poor CVH (P ≤ .03). Associations were stronger in post-menopausal and racial/ethnic minority women.

Conclusions: Better sleep habits were associated with more favorable CVH among women, suggesting that there may be benefit in incorporating sleep assessment into CVD risk screening.

Keywords: AHA Life’s Simple 7; Cardiovascular health; Menopausal status; Race/ethnicity; Sleep.

Figure 1.. Univariate Associations of Sleep Characteristics with the AHA LS7 Score

This figure displays results from Fisher’s exact test to examine whether the number of participants with a low American Heart Association Life Simple 7 score (0–8) versus a moderate or high score (9–14) varies significantly across the categories of sleep characteristics. In general, short sleepers (<7 h/night) and those with poor sleep quality, insomnia, snoring and a high risk of obstructive sleep apnea were more likely to have a low AHA LS7 score.