Poor Sleep Health Linked to Subclinical Atherosclerosis, Increased Coronary Calcium Burden


An analysis of actigraphy data obtained from the MESA Sleep Ancillary Study indicates irregularities in sleep patterns, particularly in duration and timing of sleep, were linked to increased markers of subclinical atherosclerosis, including increased coronary artery calcium burden.

Kelsie Full, PhD, MPH, of Vanderbilt University

Kelsie Full, PhD, MPH

New research from investigators at Vanderbilt University Medical Center is highlighting the impact of poor sleep health on cardiovascular risk.

AN analysis of more than 2000 patients from the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary Study, results of the analysis indicate irregularity in sleep timing and sleep duration were linked to an increased prevalence of coronary artery calcium burden, even after adjustment for other cardiovascular risk factors, obstructive sleep apnea, and other sleep-related factors.1

“This study is one of the first investigations to provide evidence of a connection between irregular sleep duration and irregular sleep timing and atherosclerosis,” said lead investigator Kelsie Full, PhD, MPH, an assistant professor of medicine in the division of epidemiology at Vanderbilt University Medical Center.2

As society, namely in the United States, has made strides in its fight to achieve ideal heart health and prevention of cardiovascular disease, a growing crisis related to sleep health was being ignored. A 2015 study published in Sleep returned results indicating the number of adults sleeping 6 hours or less per night increased by 31% from 1985.3 In the last decade, the impact of sleep health on different aspects of overall health has become a focal point of research efforts for many, including those in cardiovascular medicine.

An example of this new recognition is evident through the AHA’s addition of sleep as a metric to the organization’s Life Simple 7 in June 2022, which expanded the group and changed the moniker to Life’s Essential 8.4 At the European Society of Cardiology Congress 2022, a study presented by Aboubakari Nambiema, PhD, MPH, of the Paris Cardiovascular Research Center, suggested optimal sleep health could prevent up to 7 in 10 cases of incident cardiovascular disease among their study cohort of 7200 from the Paris Prospective Study III.5

In the current study, Full and a team of investigators sought to understand how sleep regularity might be associated with atherosclerosis through leveraging actigraphy-assessed sleep duration and timing data with subclinical atherosclerosis using data from the MESA Sleep Ancillary Study. From the study, investigators obtained 7 days of data recorded via wrist actigraphy from a cohort of 2032 patients.1

The overall study cohort had a mean age of 68.6 (SD, 9.2) years, 53.6% were women, 37.9% identified as White, 27.6% identified as Black or African American, 23.4% identified as Hispanic American, and 11.1% identified as Chinese American. As per study protocol, MESA Sleep Ancillary study participants underwent assessments of coronary artery calcium (CAC), carotid plaque presence, carotid intima-media (IMT) thickness, and the ankle-brachial index.

Among the study cohort, 1549 had data related to CAC, 1588 had a carotid plaque analytic sample, 1535 had a carotid IMT analytic sample, and 1989 had an ankle-brachial index analytic sample. For the purpose of analysis, relative risk regression models were used to calculate prevalence ratios and investigators noted these models were adjusted for demographics, cardiovascular disease risk factors, and other objectively assessed sleep characteristics including obstructive sleep apnea, sleep duration, and sleep fragmentation.1

Compared to their counterparts with more regular sleep durations, participants with greater sleep duration irregularity were more likely to have high CAC burden exceeding 300 (prevalence ratio [PR], 1.33 [95% CI, 1.03-1.71]) and have an ankle-brachial index of less than 0.9 (PR, 1.75 [95% CI, 1.03-2.95]). Analysis of associations with sleep timing revealed a similar trend, with those with a more irregular sleep timing more likely to have high CAC burden (PR, 1.39 [95% CI, 1.07-1.82]). Investigators pointed out these specific associations persisted after adjustment for cardiovascular disease risk factors as well as average sleep duration, obstructive sleep apnea, and sleep fragmentation.1

“Maintaining regular sleep schedules and decreasing variability in sleep is an easily adjustable lifestyle behavior that can not only help improve sleep, but also help reduce cardiovascular risk for aging adults,” Full added.2


  1. Full K, Huang T, Shah N, et al. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis. Journal of the American Heart Association. February 2023. doi: 10.1161/JAHA.122.027361
  2. Irregular sleeping habits may increase risk of atherosclerosis in older adults. American Heart Association. https://newsroom.heart.org/news/irregular-sleeping-habits-may-increase-risk-of-atherosclerosis-in-older-adults. Published February 15, 2023. Accessed February 15, 2023.
  3. Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep. 2015;38(5):829-832. doi:10.5665/sleep.4684
  4. Campbell P. American Heart Association Debuts Life's Essential 8, adds sleep to life's simple 7. Practical Cardiology. https://www.practicalcardiology.com/view/american-heart-association-debuts-lifes-essential-8-adds-sleep-to-lifes-simple-7. Published June 30, 2022. Accessed February 15, 2023.
  5. Iapoce C. Suboptimal sleep linked to greater likelihood of heart disease. HCP Live. https://www.hcplive.com/view/suboptimal-sleep-greater-likelihood-heart-disease. Published August 25, 2022. Accessed February 15, 2023.
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