Sleep, cardiac autonomic function, and carotid atherosclerosis in patients with cardiovascular risks: HSCAA study

Manabu Kadoya; Hidenori Koyama; Masafumi Kurajoh; Akinori Kanzaki; Miki Kakutani-Hatayama; Hirokazu Okazaki; Takuhito Shoji; Yuji Moriwaki; Tetsuya Yamamoto; Masanori Emoto; Masaaki Inaba; Mitsuyoshi Namba

doi:10.1016/j.atherosclerosis.2014.12.032

Sleep, cardiac autonomic function, and carotid atherosclerosis in patients with cardiovascular risks: HSCAA study

Atherosclerosis. 2015 Feb;238(2):409-14. doi: 10.1016/j.atherosclerosis.2014.12.032. Epub 2014 Dec 20.

Affiliations

¹ Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
² Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Electronic address: hkoyama@hyo-med.ac.jp.
³ Department of Endocrinology, Metabolism and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.

PMID: 25558036
DOI: 10.1016/j.atherosclerosis.2014.12.032

Abstract

Objectives: Behavioral and psychosocial factors have been gaining increased attention in regard to cardiovascular diseases. We evaluated sleep conditions, cardiac autonomic function, and carotid atherosclerosis in subjects who participated in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) Study.

Methods: This cross-sectional study included 330 serial patients registered in the HSCAA study who were free from past cardiovascular diseases, and prescribing α- or β-blockers. In addition to clinical background and classical cardiovascular risk factors, sleep efficiency, apnea hypopnea index (AHI), awake physical activity, heart rate variability (HRV), carotid intima-media thickness (IMT), presence of plaque and plaque score were determined.

Results: Sleep efficiency (r = -0.183) and all HRV parameters (SDNN: r = -0.202; rMSSD: r = -0.234; pNN50: r = -0.277) were significantly (p < 0.01) and negatively associated with IMT, while AHI (r = 0.220, p < 0.001) was positively associated with IMT. Similarly, sleep efficiency (r = -0.129), HRV parameters (SDNN: r = -0.170; rMSSD: r = -0.217; pNN50: r = -0.260) and AHI (r = 0.184) were also significantly (p < 0.05) associated with plaque scores. Multivariate logistic regression analyses showed that rMSSD, but not sleep efficiency or AHI, was significantly associated with carotid plaque (OR 0.74, 95% CI 0.56-0.98, p = 0.037), independent of classical risk factors. The association of rMSSD with carotid plaque remained significant even after adjustment for sleep efficiency or AHI. A comparison of risk factors in specific subgroups showed that the association of lower HRV with carotid plaque was more prominent in patients with cardiovascular risk factors including male gender, hypertension, dyslipidemia and diabetes mellitus.

Conclusion: Cardiac autonomic nervous dysfunction was independently associated with carotid atherosclerosis, independent of sleep condition. Moreover, that association was more prominent in specific subgroups with cardiovascular risk factors.

Keywords: Actigraph; Carotid plaque; Cohort study; Heart rate variability; Sleep efficiency.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Actigraphy
Adult
Aged
Autonomic Nervous System / physiopathology*
Carotid Arteries / diagnostic imaging
Carotid Artery Diseases / diagnosis
Carotid Artery Diseases / epidemiology
Carotid Artery Diseases / physiopathology*
Carotid Intima-Media Thickness
Chi-Square Distribution
Cross-Sectional Studies
Female
Heart / innervation*
Heart Rate
Humans
Japan / epidemiology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Plaque, Atherosclerotic
Risk Factors
Severity of Illness Index
Sleep*