Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women

Abstract

<div class="section"> <a class="named-anchor" id="d4350470e297"> <!-- named anchor --> </a> <h5 class="section-title" id="d4350470e298">Introduction:</h5> <p id="d4350470e300">Midlife, which encompasses the menopause transition in women, can be a time of disrupted sleep and accelerated atherosclerosis accumulation. Short or poor sleep quality has been associated with cardiovascular disease (CVD) risk; few studies have investigated relations among midlife women. We tested whether shorter actigraphy sleep time or poorer subjective sleep quality was associated with carotid atherosclerosis among midlife women. </p> </div><div class="section"> <a class="named-anchor" id="d4350470e302"> <!-- named anchor --> </a> <h5 class="section-title" id="d4350470e303">Aims and Methods:</h5> <p id="d4350470e305">Two hundred fifty-six peri- and postmenopausal women aged 40–60 years completed 3 days of wrist actigraphy, hot flash monitoring, questionnaires (Pittsburgh Sleep Quality Index [PSQI], Berlin), a blood draw, and carotid ultrasound [intima media thickness (IMT), plaque]. Associations of objective (actigraphy) and subjective (PSQI) sleep with IMT/plaque were tested in regression models (covariates: age, race, education, body mass index, blood pressure, lipids, insulin resistance, medications, snoring, depressive symptoms, sleep hot flashes, and estradiol). </p> </div><div class="section"> <a class="named-anchor" id="d4350470e307"> <!-- named anchor --> </a> <h5 class="section-title" id="d4350470e308">Results</h5> <p id="d4350470e310">Shorter objective sleep time was associated with higher odds of carotid plaque (for each hour shorter sleep, plaque score ≥ 2, odds ratio (OR) [95% confidence interval, CI] = 1.58 [1.11–2.27], <i>p</i> = .01; plaque score = 1, OR [95% CI] = 0.95 [0.68–1.32], <i>p</i> = .75, vs. no plaque, multivariable). Poorer subjective sleep quality was associated with higher mean IMT [β, <i>b</i> (standard error, <i>SE</i>) = 0.004 (0.002), <i>p</i> = .03], maximal IMT [ <i>b</i> ( <i>SE</i>) = 0.009 (0.003), <i>p</i> = .005], and plaque [plaque score ≥ 2, OR (95% CI) = 1.23 (1.09–1.40), <i>p</i> = .001; score = 1, OR (95% CI) = 1.06 (0.93–1.21), <i>p</i> = .37, vs. no plaque] in multivariable models. Findings persisted additionally adjusting for sleep hot flashes and estradiol. </p> </div><div class="section"> <a class="named-anchor" id="d4350470e343"> <!-- named anchor --> </a> <h5 class="section-title" id="d4350470e344">Conclusions:</h5> <p id="d4350470e346">Shorter actigraphy-assessed sleep time and poorer subjective sleep quality were associated with increased carotid atherosclerosis among midlife women. Associations persisted adjusting for CVD risk factors, hot flashes, and estradiol. </p> </div>