danielle_journal review

Journal Club: June 25th, 2013Review by Danielle Ross

• Longer work hours• Increases in shift

work• Round-the-clock

availability of commodities

Secular Trends andChanges In Modern

SocietyIntroduction

• Longer work hours• Increases in shift

work• Round-the-clock

availability of commodities

Secular Trends andChanges In Modern

SocietyIntroduction

Source: http://nighttherapymattress.com/sleep-studies/2011-report-the-national-sleep-foundation/

Poor Sleep Quality and

QuantityIntroduction

A comparison of two groups based on the rate of deaths.

Hazard Ratio

Source: Kripke DF et al. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002;59(2):131-136.

Hazard Ratio

A comparison of two groups based on the rate of deaths.Source: Kripke DF et al. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002;59(2):131-136.

SLE

EP

TIME

Heart Disease

Background• Coronary artery

disease• Arrhythmias• Heart infections• Congenital

heart defects, etc.

Source: http://www.mayoclinic.com/health/heart-disease/DS01120

Cardiovascular Disease (CVD)

Background • Myocardial infarction – heart attack

• Angina – chest pain

• StrokeSource: http://www.mayoclinic.com/health/heart-disease/DS01120

Coronary Heart Disease (CHD)

Background • Plaque buildup in the coronary arteries

• Atherosclerosis – over several years

Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/

Insomnia

Background• Inability to initiate

or maintain sleep• Perception of

disturbed sleep

Source: Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev 2002; 6: 97-111.

Insomnia

Background• 45% increased

morbidity/mortality from CVD

• 1 in 3 people suffer from symptoms

Source: Sofi F et al. Insomnia and risks of cardiovascular disease: A meta-analysis. European Journal of Preventative Cardiology 2012 Aug 31.

Goal

• Long/short sleep duration independently associated with CHD/CVD

• Insomnia independently associated with CHD/CVD

• Sleep duration + insomnia associated with CHD/CVD

The Women’s Health InitiativeStudy

Participants WHI161,809

Clinical Trial68,133

Control Expt.

WHI-OS93,676

Clinical Sites (40)Avg. 10.3 yrs.

Participants86,329

Primary Endpoint

Methods• Incident CHD and

incident CVD determined on

first incident (only) of disease-free cohort

Recorded Sleep Duration

• Self-reported measure evaluation

completed on baseline screening visit

Methods

Recorded Sleep Duration

• Self-reported measure evaluation

completed on baseline screening visit

Methods About how many hours

of sleep did you get on a

typical night during the

last 4 weeks?≤5h, 6h, 7h, 8h, 9h, ≥10h

Measured Insomnia

• Determined via questionnaire, using a validated WHI Insomnia Rating Scale

measures perceived insomnia

Methods

Measured Insomnia



Methods During the last 4 weeks,

how often have you

been bothered by any of

the following problems?

Measured Insomnia



Methods 1. Trouble falling asleep

2. Waking up several times

per night3. Waking up earlier than you

planned to4. Trouble getting back to

sleep after you woke too

early

Measured Insomnia



Methods5. Overall, was your typical

night’s sleep during the

past 4 weeks…a. very sound or restful

b. sound or restfulc. average qualityd. restlesse. very restless

Results

Results

≤5 6 7 8 9 ≥100

5

10

15

20

25

30

35

40

7.9

26.77

37.81

22.95

4.010.55

Sleep Duration of Sample Population

Sleep time hours/day

Perc

ent o

f N (%

)

Results

Results

≤5 6 7 8 9 ≥100

2

4

6

8

10

12 11.2

7.8

5.95 4.9

6

WHI Insomnia Rating Scale


Arb

itrar

y Sc

ale

(1-2

0)

• Age• Race

Model 1• Age• Race• Education• Income• Smoking• BMI• Physical

Activity

• Alcohol Consumption

• Depression• Diabetes• High BP• Hyperlipidemia• Comorbid

Conditions

Model 2

Results

Results

Sleep/Insomnia & CHD

Sleep/Insomnia & CVD

Results

≤5 6 7-8 (ref) 9 ≥100

10

20

30

40

50

60

8.94

27.19

59.08

4.120.67

Incident CHD v. Sleep Duration


Inci

dent

CH

D C

ases

(%)

Results

≤5 6 7-8 (ref) 9 ≥100

10

20

30

40

50

60

8.54

27.05

59.47

4.270.62

CVD Cases v. Sleep Duration


Inci

dent

CVD

Cas

es (%

)

Conclusions

‘U’-shaped curve found in the age/race adjusted model

Conclusions

High insomnia = 38% CHD and 27% CVD

Conclusions

Insomnia + Long Sleep Duration = ~ 2.0 HR for CHD

The Women’s Health Initiative• Postmenopausal

women ONLY• Small age range• Other sleep

disturbances• 0.6% occurrence of

high risk factor

Caveats

Source: Brody JE. Cheating ourselves of sleep. New York Times 2013, June 17. http://well.blogs.nytimes.com/2013/06/17/cheating-ourselves-of-sleep/

Popular Media Commentary


“the risks of cardiovascular diseases and stroke are higher in people who sleep less than six hours a night… A single night of inadequate sleep can cause daylong elevations in blood pressure in

people with hypertension… [and] higher rates of heart disease have been found in women who

sleep more than nine hours nightly.”

~ JE BrodySource: Brody JE. Cheating ourselves of sleep. New York Times 2013, June 17. http://well.blogs.nytimes.com/2013/06/17/cheating-ourselves-of-sleep/

Source: Brody JE. Cheating ourselves of sleep. New York Times 2013, June 17. http://well.blogs.nytimes.com/2013/06/17/cheating-ourselves-of-sleep/


Faculty and Staff of the WFU Primate Center,Friedburg Campus

DR. MATTHEW JORGENSEN

The Hypertension and Vascular Research Center,The Excellence In Cardiovascular Research Summer Programand Wake Forest School of Medicine.

POWERPOINT SLIDE THEME BY DUARTEwww.duarte.com,[email protected]

DR. ANN TALLANT, DR. DEBRA DIZ AND MS. NOBI SARVER

ACKNOWLEDGMENTS

http://www.duarte.com/

QUESTIONS?

Nonhuman Primate Model

Source: http://farm6.staticflickr.com/5183/5638791520_d9dd286085_b.jpg

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