Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;43(1):137-158.
doi: 10.1007/s11357-020-00312-y. Epub 2021 Feb 9.

Effects of sleep deprivation on endothelial function in adult humans: a systematic review

Brady J Holmer  1 , Stephanie S Lapierre  1 , Danielle E Jake-Schoffman  2 , Demetra D Christou  3
Affiliations

Effects of sleep deprivation on endothelial function in adult humans: a systematic review

Brady J Holmer et al. Geroscience. 2021 Feb.

Abstract

Sleep deprivation is highly prevalent and is associated with increased cardiovascular disease (CVD) morbidity and mortality. Age-related alterations in sleep and chronobiology may exaggerate CVD susceptibility in older individuals. The mechanisms responsible for the association between sleep deprivation and CVD are not fully understood, but endothelial dysfunction may play a central role. Our objective was to conduct a systematic literature review to evaluate the evidence on the effects of sleep deprivation on endothelial function (EF). This review adhered to the PRISMA guidelines and was pre-registered with PROSPERO (#CRD42020192485, 07/24/2020). We searched PubMed, Web of Science, Embase, and Cochrane Library for articles published through May 1, 2020. Eligibility criteria included publication in English and use of well-established EF methodologies in adult humans. Two investigators independently performed the literature search, study selection, data extraction, risk-of-bias assessment, and qualitative data synthesis. Out of 3571 articles identified, 24 articles were included in the systematic review. Main findings include the following: (1) shorter sleep duration is associated with lower macrovascular EF; (2) not sleeping 7-9 h/night is linked with impaired microvascular EF; (3) sleep restriction impairs micro- and macrovascular EF; (4) acute total sleep deprivation impairs micro- and macrovascular EF but data on macrovascular EF are less consistent; and (5) shift work impairs macrovascular EF. In conclusion, sleep deprivation impairs EF, which may explain the link between insufficient sleep and CVD. Future investigations should fully elucidate the underlying mechanisms and develop strategies to combat the adverse endothelial effects of sleep deprivation across the lifespan.

Keywords: Cardiovascular aging; Chronobiology; Endothelial function; Sleep deprivation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart summarizes the results of the screening process and final article selection
Fig. 2
Fig. 2
Risk of bias for observational and non-randomized experimental studies. Domain 1: bias due to confounding; domain 2: bias due to selection of participants; domain 3: bias in classification of interventions; domain 4: bias due to deviations from intended interventions; domain 5: bias due to missing outcome data; domain 6: bias in measurement of outcomes; domain 7: bias in selection of the reported result
Fig. 3
Fig. 3
Risk of bias domains across all observational/non-randomized experimental studies
Fig. 4
Fig. 4
Risk of bias for randomized experimental studies. Domain 1: bias arising from the randomization process; domain 2: bias due to deviations from intended intervention; domain 3: bias due to missing outcome data; domain 4: bias in measurement of the outcome; domain 5: bias in selection of the reported result
Fig. 5
Fig. 5
Risk of bias domains across all randomized experimental studies
Fig. 6
Fig. 6
Conceptual model of the link between sleep deprivation and cardiovascular disease. Sleep deprivation leads to inflammation, oxidative stress, autonomic nervous system dysregulation, and chronobiological disruption, which impair endothelial function and may lead to accelerated vascular aging and cardiovascular disease. SNS, sympathetic nervous system; PNS, parasympathetic nervous system; CVD, cardiovascular disease. Created with BioRender.com
See this image and copyright information in PMC

References

    1. Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of healthy sleep duration among adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(6):137–41. 10.15585/mmwr.mm6506a1. - PubMed
    1. St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL, American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134(18):e367–ee86. doi: 10.1161/CIR.0000000000000444. - DOI - PMC - PubMed
    1. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC, Adams Hillard PJ. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–43. doi: 10.1016/j.sleh.2014.12.010. - DOI - PubMed
    1. NSF. 2010 Bedroom Poll: Summary of Findings. 2012:1–79.
    1. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–432. doi: 10.1093/sleep/18.6.425. - DOI - PubMed

Publication types

LinkOut - more resources