Sleep Quality, Anxiety and Cardiovascular Disease Risk in Humans

Melissa Rader

<p>Adequate sleep duration and sleep quality are essential for maintaining cardiovascular health. Short sleep duration is associated with increased cardiovascular disease (CVD) risk, however, less is known about whether sleep quality, independent of sleep duration, is associated with CVD risk. Anxiety is also an independent risk factor for development of CVD, but how anxiety leads to CVD is unclear. Our overall hypothesis is that higher anxiety and vascular biomarkers of CVD risk (arterial stiffness and altered 24-hour blood pressure patterns) will be associated with poor sleep quality (PSQ) in healthy adults. Specifically, we hypothesize that independent of sleep duration, adults with PSQ will demonstrate: 1) increased anxiety levels compared with individuals with good sleep quality (GSQ), 2) greater aortic and carotid artery stiffness compared with individuals with GSQ; and 3) blunted nighttime blood pressure (BP) dipping and increased 24-hour BP variability compared with adults with GSQ. A total of 44 healthy participants without CVD ranging from low-to-high levels of anxiety were studied in a cross-sectional design. Participants were stratified into two groups based on their global score on the Pittsburg Sleep Quality Index (PSQI). A score of ≥5 is indicative of PSQ and a score <5 is considered GSQ. To measure anxiety, two self-report surveys (STAI inventory) were given to assess “state” and “trait” anxiety. In addition, arterial stiffness (carotid-femoral pulse wave velocity, carotid β-stiffness), 24-hour BP variability and nocturnal BP dipping using 24 hour ambulatory BP monitoring, circulating metabolic/inflammatory factors (glucose, insulin, c-reactive protein, triglycerides, HDL- and LDL- cholesterol), and conventional risk factors (age, sex, and body mass index) were analyzed. Our results demonstrated that PSQI was not associated with sleep duration (r=-0.07, P=0.68) and that anxiety (both state and trait) were higher in participants with PSQ compared with GSQ (P<0.05 vs. GSQ for both state and trait anxiety). Trait anxiety had a stronger correlation (r=0.75, P<0.001) with PSQI score than state anxiety (r=0.60, P<0.001). Among the PSQ group, as sleep quality worsened, trait anxiety also increased (r = 0.45, P = 0.02), an effect that was not observed in those with GSQ. Arterial stiffness, 24- hour BP variability and nocturnal BP dipping was not different between PSQ and GSQ. In conclusion, trait and state anxiety are strongly associated and with PSQ but the relation appears stronger with trait anxiety. PSQ was not associated with surrogate biomarkers of CVD risk. <em> </em></p>

Sleep Quality, Anxiety and Cardiovascular Disease Risk in Humans

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