Sleep Irregularity and Risk of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background: The cardiovascular system exhibits strong circadian rhythms to maintain normal functioning. Irregular sleep schedules, characterized by high day-to-day variability in sleep duration or timing, represent possibly milder but much more common and chronic disruption of circadian rhythms in the general population than shift work.

Objectives: This study aimed to prospectively examine the association between sleep regularity and risk of cardiovascular disease (CVD).

Methods: In MESA (Multi-Ethnic Study of Atherosclerosis), 1,992 participants free of CVD completed 7-day wrist actigraphy for sleep assessment from 2010 to 2013 and were prospectively followed through 2016. The study assessed sleep regularity using the SD of actigraphy-measured sleep duration and sleep-onset timing across 7 days. Incident CVD included nonfatal and fatal cardiovascular events. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for incident CVD according to SD of sleep duration and timing, adjusted for traditional CVD risk factors (including CVD biomarkers) and other sleep-related factors (including average sleep duration).

Results: During a median follow-up of 4.9 years, 111 participants developed CVD events. The multivariable-adjusted HRs (95% confidence intervals) for CVD across categories of sleep duration SD were 1.00 (reference) for ≤60 min, 1.09 (0.62 to 1.92) for 61 to 90 min, 1.59 (0.91 to 2.76) for 91 to 120 min, and 2.14 (1.24 to 3.68) for >120 min (p trend = 0.002). Similarly, compared with participants with a sleep timing SD ≤30 min, the HRs (95% confidence intervals) for CVD were 1.16 (0.64 to 2.13) for 31 to 60 min, 1.52 (0.81 to 2.88) for 61 to 90 min, and 2.11 (1.13 to 3.91) for >90 min (p trend = 0.002). Exclusion of current shift workers yielded similar results.

Conclusions: Irregular sleep duration and timing may be novel risk factors for CVD, independent of traditional CVD risk factors and sleep quantity and/or quality.

Keywords: cardiovascular disease; circadian rhythms; cohort study; risk factor; sleep patterns.

Central illustration:. Regulare and irregular sleep patterns in relation to cardiovascular disease risk.

The left panel shows 2 real examples of 7-day sleep patterns measured by actigraphy: a highly regular sleeper with approximately 10 min SD for both sleep duration and sleep onset timing and a highly irregular sleeper with >120 min for both SD measures. These 2 examples correspond to the ‘most regular’ and ‘most irregular’ categories in the figures on the right panel. Compared with those with the most regular sleep patterns, participants with the most irregular sleep patterns had >2-fold increased risk of developing cardiovascular events over a median follow-up of 4.9 years (p-trend=0.002 for both sleep duration SD and sleep onset timing SD). Abbreviations: CVD = cardiovascular disease; HR = hazard ratio; SD = standard deviation