Sleep — do sleepless nights harm the heart more than cholesterol?

Aim of the study: Short sleep duration is associated with increased cardiovascular disease (CVD) risk. However, it is uncertain whether sleep debt, a measure of sleep deficiency during the week compared to the weekend, confers increased cardiovascular risk. Because sleep disturbances increase with age particularly in women, we examined the relationship between sleep debt and ideal cardiovascular health (ICH) in older women.

Results: Mean age was 72.1 ± 6.0 years. Compared to women with no sleep debt, women with sleep debt were more likely to be obese and have hypertension (pall < .05). Linear regression models adjusted for age and race/ethnicity revealed that sleep debt was significantly associated with poorer ICH (B = -0.13 [95% CI = -0.18 to -0.08]). The relationship was attenuated but remained significant after adjustment for education, income, depression/anxiety, cumulative stress, and snoring. Sleep debt was associated with poorer ICH, despite taking into account socioeconomic status and psychosocial factors. These results suggest that weekly sleep duration variation, possibly leading to circadian misalignment, may be associated with cardiovascular risk in older women.

Aim of the study: Sleep loss and insufficient sleep are risk factors for cardiometabolic diseases, but data on how insufficient sleep contributes to these diseases are scarce.

Results: In both approaches, blood transcriptome and serum metabolome were analysed. Sleep loss decreased the expression of genes encoding cholesterol transporters and increased expression in pathways involved in inflammatory responses in both paradigms. Metabolomic analyses revealed lower circulating large HDL in the population cohorts among subjects reporting insufficient sleep, while circulating LDL decreased in the experimental sleep restriction study. These findings suggest that prolonged sleep deprivation modifies inflammatory and cholesterol pathways at the level of gene expression and serum lipoproteins, inducing changes toward potentially higher risk for cardiometabolic diseases.

Aim of the study: Obstructive sleep apnea (OSA) is independently associated with dyslipidemia. Previous studies have demonstrated that sleep fragmentation can impair lipid metabolism.

Results: The adjusted odds ratios (ORs) for various types of dyslipidemia according to MAI quartiles, as determined by logistic regression were also evaluated. MAI was found positively associated with low-density lipoprotein cholesterol (LDL-c) but not with total cholesterol (TC), triglyceride (TG) or high-density lipoprotein cholesterol (HDL-c). Furthermore, the adjusted ORs (95% confidence interval) for hyper-LDL cholesterolemia increased across MAI quartiles, as follows: 1 (reference), 1.3 (1.1-1.7), 1.6 (1.2-2.0), and 1.6 (1.2-2.1) (p = 0.001, linear trend). Sleep fragmentation in OSA is independently associated with hyper-LDL cholesterolemia, which may predispose patients with OSA to a higher risk of cardiovascular disease.

Aim of the study: The metabolic impact of inadequate sleep has not been determined in healthy individuals outside laboratories. This study aims to investigate the impact of sleep duration on five metabolic syndrome components in a healthy adult cohort.

Results: Compared to regular sleep duration, short sleep significantly (p < .001) increased the risk for central obesity by 12% (adjusted HR 1.12 [1.07-1.17]), for elevated fasting glucose by 6% (adjusted HR 1.06 [1.03-1.09]), for high blood pressure by 8% (adjusted HR 1.08 [1.04-1.13]), for low high-density lipoprotein-cholesterol by 7% (adjusted HR 1.07 [1.03-1.11]), for hypertriglyceridemia by 9% (adjusted HR 1.09 [1.05-1.13]), and for metabolic syndrome by 9% (adjusted HR 1.09 [1.05-1.13]). Long sleep decreased the risk of hypertriglyceridemia (adjusted HR 0.89 [0.84-0.94]) and metabolic syndrome (adjusted HR 0.93 [0.88-0.99]). Insomnia symptoms did not modify the effects of sleep duration. Sleep duration may be a significant determinant of metabolic health.

Aim of the study: Aim: To identify the relationship between joint sleep patterns and the incidence of cardiometabolic diseases (CMDs) and multimorbidity (CMM) as well as the mediating effects of plasma metabolites. Methods: This prospective study included 190,827 participants from the UK Biobank.

Results: A total of 152 metabolites were identified to be associated with sleep patterns, among which lipoproteins emerged as the predominant class. Most of the metabolites showed mediation effects on the association between sleep and outcomes. Conclusions: Poor sleep pattern was associated with increased risk of CMDs and CMM. Differences in metabolites, especially lipoproteins, might partially explain the association between sleep pattern and cardiometabolic health.

Aim of the study: To synthesize current evidence on how sleep deprivation, impaired sleep architecture, and circadian misalignment affect cardiovascular and metabolic regulation across autonomic, hormonal, inflammatory, and behavioral pathways, and to highlight remaining research gaps in cardiometabolic sleep medicine.

Results: Experimental and epidemiologic data consistently link short or disturbed sleep with increased incidence of hypertension, coronary artery disease, stroke, obesity, type 2 diabetes, and metabolic syndrome. Sleep loss activates the sympathetic nervous system and elevates cortisol, while suppressing growth hormone, thereby promoting vasoconstriction, endothelial dysfunction, and cardiac remodeling. Parallel disruption of leptin, ghrelin, and endocannabinoid signaling increases hunger, caloric intake, and preference for energy‑dense foods, driving weight gain, visceral adiposity, and insulin resistance. Circadian misalignment from shift work and social jet lag further amplifies inflammatory signaling and metabolic risk across the lifespan. Limited interventional data suggest that sleep extension can improve appetite regulation, blood pressure, and some glycemic indices, but mechanistic and long‑term outcomes remain underexplored.

Aim of the study: To prospectively examine how combined sleep behaviors affect vascular complications in type 2 diabetes, whether these associations are modified by disease severity, as well as the mediating roles of clinical biomarkers.

Results: Over 13.5 years, 1,878 macrovascular and 3,066 microvascular complications occurred. Compared with a healthy sleep score of 0-1, the multivariable-adjusted HRs (95% CIs) of the score 4-5 were 0.75 (0.63, 0.89) for macrovascular complications [coronary artery disease 0.72 (0.57, 0.91), stroke 0.92 (0.66, 1.28), peripheral artery disease 0.79 (0.56, 1.10)]; 0.86 (0.75, 0.99) for microvascular complications [neuropathy 0.62 (0.47, 0.83), nephropathy 1.01 (0.84, 1.21), retinopathy 0.84 (0.68, 1.03)]. The aggregated diabetes severity score (Pinteraction = 0.037) significantly modified the association with microvascular complications.

Aim of the study: Night shift work is linked to higher risks of cardiovascular disease (CVD) and mortality, but mechanisms remain unclear. Lifestyle, captured by the American Heart Association's Life's Essential 8 (LE8), may act as a modifiable mediator. We aimed to examine the associations of night shift work with CVD and mortality and quantify the mediating role of LE8.

Results: Over a median follow-up of 13.78 years (interquartile range = 13.09-14.42), 39,115 (29.7%) developed CVD and 5474 (4.2%) died. Compared with day workers, usual/permanent night shifts had higher risks of CVD (hazard ratio (HR) = 1.24; 95% confidence interval (CI) = 1.18-1.31), all-cause mortality (HR = 1.23; 95% CI = 1.07-1.41), AF (HR = 1.31; 95% CI = 1.13-1.51), and MI (HR = 1.29; 95% CI = 1.09-1.51), but not cardiovascular mortality. LE8 mediated 39.2% of the CVD association, 33.1% of all-cause mortality, and 40.8% of MI. Counterfactual analyses suggested that improving cardiovascular health (CVH) could prevent 35.1% of CVD events and 30.2% of deaths among night shift workers. Night shift work is associated with higher risks of CVD, AF, MI, and all-cause mortality. A substantial proportion of this burden may be preventable through improved CVH. Further studies are needed to evaluate integrated lifestyle interventions in night shift workers.