Sleep and Cardiometabolic Disease

Abstract

Sleep is a universal part of human physiology yet sleep disturbances such as short sleep duration and sleep apnea are common. Cardiovascular disease and its risk factors are also common, and it has been hypothesized that sleep disturbances may be linked to greater cardiovascular risk. This dissertation reports on epidemiological associations of sleep duration with eating behaviors and obesity, as well as associations between obstructive sleep apnea and cardiovascular events. Using data from Project EAT, the first manuscript examines the association between several self-reported sleep indices and problematic eating behaviors in young adults. Late sleep timing was most consistently associated with poor eating behaviors, while fewer associations were found for other sleep indices. In the second manuscript, data from the Multi-Ethnic Study of Atherosclerosis were used to evaluate the association between actigraphy-measured sleep indices and adiposity in older adults. Those sleeping less than 5 hours per night had higher BMIs, larger waists, and more kilograms of body fat than those who slept 7-8 hours a night. Those with low sleep efficiency and high sleep variability also had greater adiposity. Using data from the Sleep Heart Health Study, the third manuscript examines the relationship between daytime sleepiness and obstructive sleep apnea in relation to incident coronary heart disease and stroke. We found no significant interaction or synergy, indicating that measuring both sleep characteristics provides little additional information about cardiovascular disease incidence. In the fourth manuscript, we examine the association between diagnosed sleep apnea and atherosclerotic cardiovascular disease among patients with atrial fibrillation in the MarketScan administrative databases. Counterintuitively, we found that sleep apnea was associated with reduced risk of stroke and myocardial infarction, potentially due to error in the measurement of the exposure. This dissertation explores the epidemiology of sleep and cardiometabolic disease, including its clinical and public health implications.