Sleep duration, baseline cardiovascular risk, inflammation and incident cardiovascular mortality in ambulatory U.S. Adults: National health and nutrition examination survey

Kartik Gupta; Shivaraj Nagalli; Rajat Kalra; Rishab Gupta; Shazil Mahmood; Vardhmaan Jain; Wunan Zhou; Sumanth D Prabhu; Navkaranbir S Bajaj

doi:10.1016/j.ajpc.2021.100246

Sleep duration, baseline cardiovascular risk, inflammation and incident cardiovascular mortality in ambulatory U.S. Adults: National health and nutrition examination survey

Am J Prev Cardiol. 2021 Aug 17:8:100246. doi: 10.1016/j.ajpc.2021.100246. eCollection 2021 Dec.

Authors

Kartik Gupta^{1

2}, Shivaraj Nagalli³, Rajat Kalra⁴, Rishab Gupta⁵, Shazil Mahmood¹, Vardhmaan Jain⁶, Wunan Zhou⁷, Sumanth D Prabhu^{2

8}, Navkaranbir S Bajaj^{2

8

9}

Affiliations

¹ Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, U.S.A.
² Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, AL, U.S.A.
³ Yuma Regional Medical Center, Yuma, AZ, U.S.A.
⁴ Cardiovascular Division, University of Minnesota, Minneapolis, MN, U.S.A.
⁵ Department of Psychiatry, State University of New York Downstate Medical Center, Brooklyn, NY, U.S.A.
⁶ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, U.S.A.
⁷ Cardiology Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, U.S.A.
⁸ Section of Cardiology, Birmingham Veteran Affairs Medical Center, Birmingham, AL, U.S.A.
⁹ Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, AL, U.S.A.

Abstract

Introduction: The interplay between sleep duration and inflammation on the baseline and incident cardiovascular (CV) risk is unknown. We sought to evaluate the association between sleep duration, C-reactive protein (CRP), baseline CV risk, and incident CV mortality.

Methods: We used data from the National Health and Nutrition Examination Survey 2005-2010 linked with the cause of death data from the National Center for Health Statistics for adults aged ≥18 years. The associations between self-reported sleep duration and CRP, 10-year atherosclerotic CV disease risk score (ASCVD) and CV mortality were assessed using Linear, Poisson and Cox proportional hazard modeling as appropriate.

Results: There were 17,635 eligible participants with a median age of 46 years (interquartile range [IQR] 31, 63). Among them, 51.3% were women and 46.9% were non-Hispanic Whites. Over a median follow-up of 7.5 years (IQR 6.0, 9.1), 350 CV deaths occurred at an incident rate of 2.7 per 1000-person years (IQR 2.4, 3.0). We observed a U-shaped associations between sleep duration and incident CV mortality rate (P-trend=0.011), sleep duration and 10-year ASCVD risk (P-trend <0.001), as well as sleep duration and CRP (P-trend <0.001). A self-reported sleep duration of 6-7 hours appeared most optimal. We observed that those participants who reported <6 or >7 hours of sleep had higher risk of CV death attributable to inflammation after accounting for confounders.

Conclusions: There was a U-shaped relationship of incident CV mortality, 10-year ASCVD risk, and CRP with sleep duration. These findings suggest an interplay between sleep duration, inflammation, and CV risk.

Keywords: ASCVD; Cardiovascular; Inflammation; Sleep.