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Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence

Abstract

Short sleep duration has a substantial influence on the overall health of an individual. Short sleep time can be a consequence of lifestyle habits, environmental factors, or the presence of a sleep disorder, such as insomnia or sleep-disordered breathing. Short sleep time is associated with increased morbidity and mortality, mainly from cardiovascular disorders (including coronary artery disease, arrhythmias, and hypertension). Several biological mechanisms have been proposed as a possible link between short sleep duration and these diseases, such as involvement of the autonomic nervous system, endothelial function, metabolic regulation, inflammation, and the coagulation system. In this Review, we provide an overview on the effects of short sleep duration on cardiovascular health and diseases and discuss the main pathophysiological mechanisms involved, taking into account both experimental data and clinical evidence.

Key points

  • Regardless of the underlying cause, short duration of sleep seems to be associated with increased morbidity and mortality.

  • Experimental data show that sleep deprivation causes important alterations in several intermediate biological mechanisms, such as the autonomic nervous system, endothelial function, insulin and glucose regulation, inflammation, and coagulation.

  • Although a causal relationship between short sleep duration and cardiovascular risk is not confirmed, most of the data indicate a strong link between short sleep times and diabetes mellitus, obesity, and cardiovascular disorders.

  • Physicians should consider sleep to be a modifiable risk factor for health status, with particular relevance to cardiovascular and metabolic disorders.

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Fig. 1: Pathophysiological pathways linking short sleep duration and risk of cardiovascular disease.
Fig. 2: Autonomic nervous system and short sleep duration.
Fig. 3: General effects of short sleep duration on different organs and systems.

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Acknowledgements

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Nature Reviews Cardiology thanks M. A. Grandner, O. Oldenburg and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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E.T., E.M.F., and N.M. researched data for the article and wrote the manuscript. E.T., M.S., G.C., L.N., and N.M. discussed the content of the article, and E.M.F., M.S., G.C., L.N., and N.M. reviewed and edited it before submission.

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Glossary

Actigraphy

A method for noninvasive monitoring of rest and activity cycles in humans via a wrist-worn device; although actigraphy is not the gold standard for diagnosing a sleep disorder, it is a useful research tool because data can be recorded inexpensively and in a natural sleep environment.

Polysomnography

A type of sleep study, based on the simultaneous recording of several biological functions during sleep (electrocardiogram, respiration, brain activity, muscles, and ocular movements); in clinical practice, polysomnography is the gold-standard technique for recording sleep and diagnosing sleep disorders.

Non-dipper profile

In ambulatory blood-pressure monitoring, a non-dipper profile is characterized by the absence of a physiological fall in blood pressure during night time compared with daytime.

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Tobaldini, E., Fiorelli, E.M., Solbiati, M. et al. Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence. Nat Rev Cardiol 16, 213–224 (2019). https://doi.org/10.1038/s41569-018-0109-6

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