Healthier Sleep Pattern Tied to Lower Risk of Heart Failure

By Lisa Rapaport

November 19, 2020

(Reuters Health) - Healthy sleep patterns are associated with reduced risk of developing heart failure, even after accounting for other risk factors such as hypertension and diabetes, a study of UK Biobank participants suggests.

Researchers examined sleep data on 408,802 participants in the Biobank study with no history of heart failure at baseline. Each participant completed questionnaires about chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness, and researchers evaluated their sleep on a 5-point scale with top scores indicating the healthiest sleep pattern: an early chronotype, sleeping 7-8 hours, little or no insomnia, and no snoring or excessive daytime sleepiness.

After a median follow-up period of 10.1 years, a total of 5,221 (1.3%) people developed heart failure.

Each 1-point increase in healthy sleep score was associated with a 15% reduction in heart failure risk, according to the report in Circulation.

"A high proportion of the study participants had a very healthy sleep pattern in our study," said senior study author Lu Qi of the School of Public Health and Tropical Medicine at Tulane University in New Orleans.

"This suggests it is not unfeasible to improve the sleep pattern from an unhealthy pattern to a healthy pattern," Qi said by email. "Indeed, it has been shown in previous studies that exercise and healthy eating habits may help improve sleep quality."

Compared to those with the unhealthiest sleep scores of 0-1, participants with sleep scores of 4-5 had the lowest risk of heart failure (hazard ratio 0.58).

When researchers examined each of the five components of the healthy sleep pattern separately, only self-reported snoring was not significantly associated with reduced risk.

Heart failure risk was lower with an early chronotype (HR 0.92), sleeping 7-8 hours a day (HR 0.88), no frequent insomnia (HR 0.83), and no frequent daytime sleepiness (HR 0.66). A lack of self-reported snoring was also tied to reduced risk, but this association wasn't statistically significant.

The analysis adjusted for age, ethnicity, sex, alcohol intake, smoking status, physical activity, sedentary time, diet, income, education, diabetes, hypertension, genetic risk for heart failure, and use of medications to manage hypertension, cholesterol and insulin.

One limitation of the study is that self-reported sleep behaviors may have been subject to recall bias or misclassification, the study team notes. The researchers also lacked data on changes in sleep behaviors over time.

It's possible that healthy sleep might be associated with a lower risk of heart failure because individuals who sleep well have a healthier lifestyle than those who don't, said Dr. Nieca Goldberg, medical director of the New York University Women's Heart Program in New York City. It's also possible that those with unhealthy sleep problems have obesity, which may lead to sleep apnea and arrhythmias, or untreated hypertension.

Clinicians should consider sleep testing to help diagnose apnea and treatment with CPAP, as well as weight loss to improve sleep in individuals with obesity, Dr. Goldberg, who wasn't involved in the study, said by email.

"Healthy sleep is important," Dr. Goldberg said. "Unhealthy sleep raises risk for high blood pressure, diabetes, heart failure and a poor quality of life."

SOURCE: Circulation, online November 16, 2020.