New study findings may have important clinical and public health implications, such as screening for changes in sleep duration by primary care physicians as a potential risk factor for cardiovascular disease, or initiating public health initiatives focusing on improving sleep quality and quantity," said Shankar.
Researchers know that lack of sleep can lead to impaired glucose tolerance, reduced insulin sensitivity and elevated blood pressure.
Shankar and lead author Charumathi Sabanayagam, MD, analyzed data from 30,397 adults who participated in the 2005 National Health Interview Survey, which collected information on demographic factors, socioeconomic characteristics, lifestyle and health.
Sleep duration was assessed by the question, "On average, how many hours of sleep do you get in a 24-hour period?" Participants reported 2,146 cases of cardiovascular disease, which was defined as a physician diagnosis of angina, coronary heart disease, heart attack or stroke.
Sleeping fewer than five hours a day, including naps, more than doubles the risk of being diagnosed with angina, coronary heart disease, heart attack or stroke, the study conducted by researchers at West Virginia University's (WVU) faculty of medicine and published in the journal Sleep.
The study found sleeping more than seven hours also increases the risk of cardiovascular disease. Study participants who say they slept nine hours or longer a day, were one-and-a-half times more likely than seven-hour sleepers to develop cardiovascular disease.
The most at-risk group was adults under 60 years of age who slept five hours or fewer a night. An elevated but less dramatic risk of cardiovascular disease also was found with reported daily sleep durations of six hours (Odds Ratio = 1.33) and eight hours (OR = 1.23). The association between a daily sleep duration of five hours or less and cardiovascular disease was strongest in adults under 60 years of age (OR = 3.08) and in women (OR = 2.57). When subjects with diabetes, hypertension or depression were excluded from the analysis, the association with cardiovascular disease remained high for sleep durations of five hours or less (OR = 2.26) and nine hours or more (OR = 2.04).
They increased their risk of developing cardiovascular disease more than threefold compared to people who sleep seven hours. Sleep disturbances may be a risk factor for cardiovascular disease even among apparently healthy subjects.
Women who skimped on sleep, getting five hours or fewer a day including naps, were more than two-and-a-half times as likely to develop cardiovascular disease.
Short sleep duration was associated with angina, while both sleeping too little and sleeping too much were associated with heart attack and stroke.
Effect unclear
The authors of the WVU study were unable to determine the causal relationship between how long a person sleeps and cardiovascular disease. Additional mechanisms underlying the association between short sleep and cardiovascular disease may include sleep-related disturbances in endocrine and metabolic functions.
The negative effects of sleep deprivation include impaired glucose tolerance, reduced insulin sensitivity, increased sympathetic activity and elevated blood pressure, all of which increase the risk of hardening of the arteries. Long sleep duration may be related to an underlying sleep-related breathing disorder or poor sleep quality.
The American Academy of Sleep Medicine recommends that most adults get about seven to eight hours of sleep each night.
These study findings may have important clinical and public health implications, such as screening for changes in sleep duration by primary care physicians as a potential risk factor for cardiovascular disease, or initiating public health initiatives focusing on improving sleep quality and quantity," said Shankar.
Dr Andrew Scott, Sleep Physician, recommends that this study be treated with caution. “This study answers the interesting question of ‘how much’ but does not address the quality of each hour of sleep achieved in this study”. It is well recognised that sleep quantity changes with age, physical fitness and exercise as well.
Sleeping in
A separate study, also published in Sleep, showed that an occasional long lie-in can be beneficial for those who cannot avoid getting too little sleep.
In that study , David Dinges, who heads the sleep and chronobiology unit at the University of Pennsylvania, found 142 adults whose sleep was severely restricted for five days - as it is for many people during the work week - had slower reaction times and more trouble focusing.
But after a night of recovery sleep, the sleep-deprived study participants' alertness improved significantly, and the greatest improvements were seen in those who were allowed to spend 10 hours in bed after a week with just four hours sleep a night.
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