Association Between Sleep Duration and Angina Characteristics in United States Adults

Abstract

Background: Sleep is now recognized as a key factor in cardiovascular health by the American Heart Association's Life's Essential 8. However, the relationship between sleep duration and stable angina remains unexplored.

Methods: This nationally representative cross-sectional study analyzed data from 18,385 U.S. adults aged 40 and older using the National Health and Nutrition Examination Survey (2005-2018). Daily sleep duration was categorized as <7 hours, 7-8 hours (reference), and >8 hours. Angina was assessed with the Rose Angina Questionnaire and classified by severity (Grade 1 or 2) and pain location (typical vs atypical). Covariates were identified a priori based on previous literature, and clinical relevance.

Results: Our study included 18,385 adults with a mean age of 57.6 years (SE 0.16). Out of these, 48.6% were female and 70% were non-Hispanic Whites. A total of 954 (5.2 %) participants reported experiencing angina. Among those with angina, 109 (11%) reported atypical symptoms. Univariate analysis revealed that both short (<7 hours) and long (>8 hours) sleep durations were associated with higher odds of Grade 2 angina compared to adequate sleep (7-8 hours). Adjusted analysis showed significantly higher odds of Grade 2 angina in individuals sleeping >8 hours (OR [95% CI]: 2.16 [1.08-4.32] for females; 2.69 [1.15-6.29] for males). Additionally, sleep <7 hours was associated with a greater likelihood of atypical angina presentation (OR: 1.77 [1.21-3.05]).

Conclusion: Our findings suggest that sleeping over 8 hours increases the likelihood of Grade 2 angina, while under 7 hours is linked to atypical presentations, complicating diagnosis. Clinicians could incorporate brief sleep assessments-asking about duration and quality-alongside angina tools like the ROSE questionnaire to identify potential sleep-related factors. While promising, these associations require further research before being translated into definitive clinical guidelines for angina management.

Keywords: Angina; Cross-Sectional; NHANES; Sleep duration.

Figure 1

Flowchart of participant selection. A total of 18,385 adults aged 40 years and older were included in the final analysis. Participants younger than 40 years (n = 9819), those with incomplete chest pain or sleep data (n = 5), and individuals with missing information on key confounding variables (n = 1670) were excluded.

Figure 2

Distribution of sleep duration in the study population. This graph displays the percentage of participants by reported hours of sleep. The distribution follows a bell-shaped curve, with the highest proportion of individuals sleeping 6 to 8 hours per day.

Figure 3

Percentage distribution of angina severity by sleep duration. This bar graph shows the proportion of individuals with Grade 1 (blue) and Grade 2 (red) angina symptoms across different sleep duration categories. The values are shown relative to the total population, highlighting differences in symptom severity with varying sleep durations.