Healthy sleep score and incident cardiovascular diseases: the Paris Prospective Study III (PPS3)

Abstract

Background/Introduction: Most studies on the association between sleep habits and cardiovascular disease (CVD) have focused on one single sleep dimension, essentially sleep duration and sleep apnea.

Purpose: To examine the joint effect of several dimensions of sleep habits at baseline and over time with incident CVD (coronary heart disease or stroke) in a community-based prospective cohort.

Methods: Between 2008−2011, 10 157 men and women aged 50 to 75 years were recruited in a preventive medical center. They underwent a standard physical examination coupled with standard biological tests, and provided information related to lifestyle, personal and family medical history, current health status, and medication use on questionnaires. Sleep habits were self-reported on validated questionnaires that assess sleep duration and insomnia complaints (Pittsburg questionnaire), early chronotype, sleep apnea (Berlin questionnaire) and subjective daytime sleepiness (Epworth questionnaire). Each sleep dimension was assigned 1 point if optimal and 0 point otherwise. A healthy sleep score ranging from 0 to 5 (the higher the better) and reflecting the number of optimal sleep dimensions was computed: early chronotype, sleep duration of 7–8 h/day, never/rarely insomnia, no sleep apnea, and no frequent excessive daytime sleepiness. The occurrence of incident CVD events
including coronary heart disease and stroke was followed every two years up to September 2020, and events were validated after review of the medical records. The multivariable association between higher healthy sleep score and CVD events was examined in proportional hazard Cox regression analysis. Population-attributable fractions were calculated to estimate the proportion of CVD cases that could be prevented by healthier sleep habits.

Results: This study included 7200 participants (62% of men, mean age: 59.7 years±6.2) who were free of CVD at baseline and had complete data on sleep habits and covariates. Among them, 7.9% had a poor sleep score (healthy sleep score of 0 or 1), and 10.1% had an optimal sleep score (score of 5). After a median follow-up of 8 years, 274 participants had incident CVD events. After adjustment for age, sex, total alcohol consumption, socioprofessional categories, smoking status, body mass index, physical activity, family history of heart diseases, LDL and HDL cholesterol, and diabetes status, the risk of CVD decreased by 22% (HR=0.78 [95% CI: 0.71–0.86]) per 1 point increment in the healthy sleep score, and there was a 75% risk reduction in CVD risk (HR=0.25 [0.13–0.49]) between participants with the highest (score of 5) and those with the lowest (score of 0–1) healthy sleep score. Under the hypothesis that all the participants would achieve an optimal sleep score of 5, 72.0% of incident CVD could be potentially avoided each year.

Conclusion(s): In this community-based prospective cohort, our preliminary results showed that a higher healthy sleep score combining 5 sleep dimensions was associated with a lower risk of CVD. This study supported strong collaboration between sleep medicine and CVD medicine.

Full text

A. Nambiema1*, Q. Lisan1, MC. Perier1, F. Thomas2, N. Danchin2, P. Boutouyrie1, X. Jouven1, JP. Empana1
1INSERM, Paris Cardiovascular Research Center (PARCC), Paris, France, Paris, France; 2Investigations Preventives et Cliniques, Paris, France
*Corresponding author: E-mail: aboubakari.nambiema@inserm.fr
Healthy sleep score and incident cardiovascular diseases:
the Paris Prospective Study III (PPS3)
Purpose
To examine the joint effect of
several dimensions of sleep
habits with incident
cardiovascular diseases (CVD)
events in acommunity‐based
prospective cohort.
Methods
▪PPS3is an ongoing prospective cohort of 10 157 healthy men and women aged 50 to 75 years recruited in a large preventive health centre between 2008-
2012 in Paris (France)
▪Incident CVD events (coronary heart disease or stroke) reported every two years were clinically validated after the review of the medical records for 10 years
▪Main exposure:Healthy sleep score including 5 sleep habits: early chronotype, sleep duration of 7–8 h/day, never/rarely insomnia, no sleep apnea, no
frequent excessive daytime sleepiness
▪Association of the baseline and change over time in healthy sleep score with incident events using a Cox regression analysis
▪Estimation of population attributable fractions (PAFs)
Conclusions
In this community-based prospective cohort, a higher healthy sleep score combining 5 sleep dimensions was associated with a lower risk of CVD. This study supported strong collaboration between
sleep medicine and CVD medicine.
Healthy sleep score includes early chronotype, sleep duration of 7–8 h/day, never/rarely insomnia, no sleep apnea, and no frequent excessive daytime sleepiness.
Cases: incident cases of coronary heart disease or stroke. The adjustment variables in Cox proportional hazards models were as follows: sex, age (continuous),
alcohol consumption, physical activity, smoking status, socioprofessional categories, diabetes mellitus, family history of heart diseases (stroke or myocardial
infarction or sudden death), low–density lipoprotein cholesterol and high–density lipoprotein cholesterol. CI: confidence interval. HR: hazard ratio. PAF: population
attributable fraction.
Results (1/2) –Baseline healthy sleep score
Healthy sleep score includes early chronotype, sleep duration of 7–8 h/day, never/rarely insomnia, no sleep apnea, and no frequent excessive
daytime sleepiness. Change: absolute difference between the follow-up score and the baseline score. Cases: incident cases of coronary heart
disease or stroke. HR: hazard ratio. Continuous change healthy sleep score: HR for a 1 point increase in the change score.
Results (2/2) –Change over time in the healthy sleep score