Association of actigraphy-measured sleep parameters and subclinical - - PowerPoint PPT Presentation

Association of actigraphy-measured sleep parameters and subclinical atherosclerotic burden: the PESA study

Fernando Domínguez, MD, PhD ; Valentín Fuster, MD, PhD ; Juan Miguel Fernández-Alvira, PhD; Leticia Fernández-Friera, MD, PhD; Beatriz López Melgar, MD, PhD; Ruth Blanco-Rojo, PhD; Antonio Fernández-Ortiz, MD, PhD; Pablo García-Pavía, MD, PhD ; Javier Sanz, MD; Jose M Mendiguren, MD; Borja Ibañez, MD, PhD; Héctor Bueno, MD, PhD; Enrique Lara-Pezzi, PhD; José M. Ordovás, PhD Sources of funding: The PESA study is co-funded equally by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain,

and Banco Santander, Madrid, Spain. The study also receives funding from the Institute of Health Carlos III (PI15/02019) and the European Regional Development Fund (ERDF). The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MEIC) and the Pro CNIC Foundation, and is a Severo Ochoa Center

• f Excellence (MEIC award SEV-2015-0505).

Conclusions

• Sleeping less than six hours or waking up several times in the night (fragmented

sleep) is associated with an increased risk of asymptomatic atherosclerosis.

• Prevalence of metabolic syndrome is directly associated with abnormal sleep

patterns, which depicts a population with unhealthier habits.

 Some evidence suggests that short and long sleep duration, as well as poor quality of sleep, are associated with an increased risk of cardiovascular disease  However, large studies evaluating objectively measured sleep parameters and subclinical atherosclerosis assessed by multimodality imaging approach are still lacking.

ARE POOR SLEEP HABITS LINKED TO THE HARDENING OF THE ARTERIES?

Background

PESA baseline cohort = 4184

No actigraphic recording n=133 Sleep apnea diagnosis n= 77 2488 men (62.6%)

3D VUS

n= 3804

CAC score

n= 3899

Clinical characteristics Subclinical non-coronary atherosclerosis Subclinical coronary calcification Sleep duration groups:  VSSD (<6h): n= 1071  SSD (6-7h): n= 1521  RSD (7-8h, reference): n= 1222  LSD (>8h): n=160

n= 3974

Sleep fragmentation groups:  n=774-787 in each quintile  Quintile 5 (more fragmented)  Quintile 1 (less fragmented, reference)

Main objective:

To evaluate the association of actigraphy- measured sleep parameters with asymptomatic atherosclerosis in a large population included in the PESA study.

Purpose and key points about methods

Sleep is not adequately quantified with subjective questionnaires

Results

ü ü

• Number
• f

territories affected (1-4)

0.1 1 1 Women >8h Men >8h >8h Women 6-7h Men 6-7h 6-7h Women <6h Men <6h <6h

Odds ratio

Sleep duration

• Noncoronary

plaque burden

• (mm3)

. 1 1 1 Women >8h Men >8h >8h Women 6-7h Men 6-7h 6-7h Women <6h Men <6h <6h

Odds ratio

Sleep duration

<6H MEN<6H WOMEN<6H 6-7H MEN 6-7H WOMEN 6-7H >8H MEN>8H WOMEN>8H <6H MEN<6H WOMEN<6H 6-7H MEN 6-7H WOMEN 6-7H >8H MEN>8H WOMEN>8H

OR (CI 95%) p value 1.27 (1.06-1.52) 0.008 1.21 (0.98-1.49) 0.08 1.48 (1.06-2.07) 0.02 1.10 (0.94-1.30) 0.25 1.13 (0.93-1.38) 0.23 1.01 (0.76-1.36) 0.90 1.31 (0.92-1.85) 0.13 0.96 (0.59-1.56) 0.87 1.83 (1.12-3.01) 0.02 OR (CI 95%) p value 1.21 (1.02-1.45) 0.03 1.14 (0.93-1.41) 0.21 1.38 (1.00-1.93) 0.053 1.07 (0.9-1.26) 0.40 1.04 (0.85-1.27) 0.71 1.12 (0.84-1.48) 0.44 1.13 (0.79-1.13) 0.50 0.85 (0.50-1.35) 0.44 1.65 (1.01-2.72) 0.05

NONCORONARY PLAQUE BURDEN (mm3) NUMBER OF TERRITORIES AFFECTED (1-4)

SLEEP DURATION

(Reference: 7-8h)

SLEEP FRAGMENTATION

±

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Very short sleep duration

ü ü ü ü ü ü ü

<6h of sleep: more atherosclerosis

Results

ü ü

Odds ratio Odds ratio

• Noncoronary

plaque burden

0. 1 1 1 Women 2nd Q Men 2nd Q 2nd Quintile Women 3rd Q Men 3rd Q 3rd Quintile Women 4th Q Men 4th Q 4th Quintile Women 5th Q Men 5th Q 5th Quintile

Odds ratio

5TH QUINTILE MEN 5TH Q WOMEN 5TH Q 4TH QUINTILE MEN 4TH Q WOMEN 4TH Q 3RD QUINTILE MEN 3RD Q WOMEN 3RD Q 2ND QUINTILE MEN 2ND Q WOMEN 2ND Q OR (CI 95%) p value 1.23 (1.00-1.52) 0.048 1.29 (1.00-1.66) 0.048 1.15 (0.79-1.67) 0.47 0.90(0.73-1.11) 0.33 1.01 (0.78-1.30) 0.95 0.70 (0.48-1.02) 0.07 0.88 (0.71-1.08) 0.23 0.96 (0.74-1.24) 0.76 0.73 (0.59-1.06) 0.10 0.88 (0.72-1.09) 0.25 0.87 (0.67-113.) 0.29 0.92 (0.65-1.31) 0.64

• Number
• f

territories affected (1-4)

0.1 1 10 Women 2nd Q Men 2nd Q 2nd Quintile Women 3rd Q Men 3rd Q 3rd Quintile Women 4th Q Men 4th Q 4th Quintile Women 5th Q Men 5th Q 5th Quintile

Odds ratio

Sleep fragmentation

5TH QUINTILE MEN 5TH Q WOMEN 5TH Q 4TH QUINTILE MEN 4TH Q WOMEN 4TH Q 3RD QUINTILE MEN 3RD Q WOMEN 3RD Q 2ND QUINTILE MEN 2ND Q WOMEN 2ND Q OR (CI 95%) p value 1.34 (1.09-1.64) 0.006 1.43 (1.12-1.85) 0.005 1.18 (0.81-1.71) 0.38 0.95(0.77-1.74) 0.65 1.10 (0.84-1.42) 0.48 0.70 (0.48-1.02) 0.07 0.90 (0.73-1.10) 0.31 1.01 (0.78-1.30) 0.96 0.71 (0.49-1.03) 0.07 0.94 (0.76-1.16) 0.54 0.93 (0.72-1.21) 0.60 0.97 (0.68-1.36) 0.84

NONCORONARY PLAQUE BURDEN (mm3) NUMBER OF TERRITORIES AFFECTED (1-4)

SLEEP FRAGMENTATION

(Reference: Quintile 1, less fragmented sleep)

±

Figure 3 Forest plots showing the

• dds

ratios and confidence intervals

• f

total plaque burden measured by 3D echo (carotid and femoral territories) and affected territories in the different groups í í á á ó á í í ñ é é á

é í ó é í ó

ü ü ü ü ü ü ü

More fragmented sleep: more arterial territories with atherosclerosis

Results

Key messages

• Sleep is an important factor influencing cardiovascular health  both short and

fragmented sleep could have a role as markers of cardiovascular risk.

• A good night´s sleep is important for cardiovascular health

 Take steps to achieve good sleep hygiene: physical activity, avoid coffee / fatty foods before bedtime…

STEERING COMMITTEE Valentín Fuster (Chairman) PESA Principal Investigator Antonio Fernández-Ortiz PESA Scientific Coordinator José María Mendiguren Bank of Santander Leader Borja Ibáñez CNIC Director Clínical Res Dpt Vicente Andrés CNIC Director Basic Res Dpt Alberto Sanz CNIC Managing Director DEDICATED COMMITTEES Javier Sanz Basic & Advance Imaging José María Ordovás Systems Biology & Lifestyle Enrique Lara Systems Biology & Biomarkers Héctor Bueno Clinical Events Adjudication José Manuel García-Ruiz Statistics & Data Management

Angel Ciprés PESA Project Manager

Juan Miguel Fernández-Alvira Leticia Fernández-Friera Beatriz López Melgar Pablo García-Pavía Ruth Blanco-Rojo

Acknowledgements