SLEEP 2022: Research Validates the Impact of Sleep Disturbances on Overall Health and Well-Being

Research has clearly established that having healthy sleep habits and obtaining enough sleep can have a positive impact on one’s mental and physical health, as well as overall health-related quality of life and productivity.¹

According to the Centers for Disease Control and Prevention (CDC), about 1 in 3 adults in the United States report getting fewer than 7 hours of sleep per day.^1,2 Moreover, the National Institutes of Health (NIH) indicates an approximately 40% of adults report falling asleep during the day without intending to at least once per month, and an estimated 50-70 million Americans have chronic sleep disorders.¹

In 2021, the American Academy of Sleep Medicine (AASM) highlighted the significance of obtaining good quality sleep. The AASM issued a position statement noting that sleep is essential to health, calling for better emphasis on sleep health in education, clinical practice, inpatient and long-term care, public health promotion, and the workplace.³

Findings from various research presentations at the recent SLEEP 2022 annual meeting continue to highlight the importance of sleep quality for overall health and well-being. Below are highlights of a few of those presentations and other recent publications exploring sleep health:  

Sleep Disturbances With Cardiac, Neurological Conditions

According to findings from a study⁴ presented at SLEEP 2022, an estimated 52% of patients who came to an academic health care center with cardiac or neurological conditions also had obstructive sleep apnea (OSA) or other sleep disturbances.

For the study, researchers conducted a retrospective electronic chart review of patient data based on various biomarkers, including cardiac testing and neurologic testing, and classified patients by type of disease. Cardiac conditions included coronary artery disease, ischemic and nonischemic cardiovascular disease, heart failure, and cardiac arrhythmias, and neurologic conditions included Alzheimer disease, mild cognitive impairment, dementia, and vascular etiology.

The researchers concluded that patients with cardiac and/or neurologic conditions also presented with OSA or sleep disturbance symptoms at a greater rate than that detected in the general population.

Improving Sleep With Weight Loss, Lifestyle Interventions

In another randomized study⁵ published in JAMA Network Open, researchers evaluated the effect of an interdisciplinary weight loss and lifestyle intervention on OSA and comorbidities. The study included adult males with moderate to severe OSA and overweight or obesity.

In the study, patients were randomized to receive standard care, which was continuous positive airway pressure (CPAP) therapy, or “an 8-week weight loss and lifestyle intervention involving nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation combined with usual care.”Nearly half (45%) of the participants receiving the intervention no longer required CPAP therapy at 8 weeks, and at 6 months, this number rose to 62%.

“In this study, an interdisciplinary weight loss and lifestyle intervention involving Spanish men with moderate to severe OSA and had overweight or obesity and were receiving CPAP therapy resulted in clinically meaningful and sustainable improvements in OSA severity and comorbidities as well as health-related quality of life. This approach may therefore be considered as a central strategy to address the substantial impact of this increasingly common sleep-disordered breathing condition,” researchers concluded.

Chronic Obstructive Pulmonary Disease Exacerbation

According to a study⁶ published in a recent issue of Sleep, poor sleep is linked with a considerably heightened risk of life-threatening flare-ups in individuals with chronic obstructive pulmonary disease (COPD).

Researchers documented COPD flare-ups over 3 years as well as participants’ sleep quality. The researchers examined self-reported sleep quality­ using 7 sleep measures, including sleep duration, timing, and frequency of disturbances.

The researchers reported their results after assessing how an individual's risk for flare-ups changed after 1 year. Study authors discovered poor sleep quality was robustly correlated with a greater total number of COPD flare-ups. Compared individuals who had the best possible sleep, those who experienced poor sleep and the worst sleep had a 25% and 95% increased risk, respectively, of a COPD exacerbation within the next year.

The authors noted poor sleep quality may contribute to future exacerbations among patients with COPD.

Sleep Regularity and Hypertension Risk

Another study⁷ published in Sleep examined associations between sleep regularity and hypertension in a large, global sample over multiple months.

Sleep and blood pressure data showed that irregularities in sleep timing and duration were associated with an augmented risk of hypertension. Results reveal that elevated sleep duration irregularity was correlated with a 9% to 15% increased risk of hypertension. Furthermore, a 38-minute increase in sleep midpoint irregularity correlated with an 11% risk increase, while a 31-minute increase in sleep onset time irregularity was linked to a heightened risk of 29%.

The authors concluded that the data provide further understanding into the impact of sleep irregularities on cardiovascular health.

COVID-19 Associated With Short Sleep

According to findings from a large US study⁸ presented at SLEEP 2022, a history of COVID-19 almost doubled the odds of experiencing very short sleep.

Researchers used data from the 2020 National Health Interview Survey to analyze the correlation between past COVID-19 diagnosis and sleep health among 17,636 adults.Participants were queried about the number of hours of sleep in a 24-hour period and sleep quality, including trouble falling or staying asleep.

According to the researchers, 4.2% of study participants tested positive for COVID-19, and of these, 3.1% had very short sleep (4 hours or less), 24.2% had short sleep (5-6 hours), 59.9% had healthy sleep (7-8 hours) and 12.8% had long sleep (9 hours or more). The study also showed 37% of participants had trouble falling asleep some days, 10.9% had trouble most days, and 6.5% had trouble every day.

In addition, 33.7%, 13.9%, and 6.6% of people had trouble staying asleep some days, most days, every day, respectively.

“Having a history of COVID-19 almost doubled the odds of having very short sleep—less than 5 hours. However, there were no significant associations between a past diagnosis of COVID-19 and other sleep quantity categories and trouble falling and staying asleep,” said Marie-Rachelle Narcisse, PhD, MSc, BSc, University of Arkansas for Medical Sciences, the lead author of the study. “It is important for health care professionals to consider a history of COVID-19 when addressing sleep deprivation in their patients.”

Efforts to Expand Awareness About Healthy Sleep Habits

The Sleep Foundation’s 2022 Sleep in America Poll surveyed participants in the United States and revealed the following, according to the associated press release:⁹

• nearly half of Americans say they aren't exposed to the recommended levels of bright light when indoors in the morning and afternoon;
• more than one-third of Americans fall short of CDC's recommendations for moderate or vigorous activity, another key factor in ensuring a sound sleep;
• 4 in 10 Americans eat meals at inconsistent times, making it more difficult for their bodies to regulate the sleep/wake process; and
• more than half of Americans indulge in screen time within an hour before bed or even while in bed.

The findings reveal the impact that daytime behaviors can have on sleep and highlight measures that individuals can employ into their daily routine to improve their quality of sleep establish a bedtime routine. These can include improving sleep hygiene.

In a recent press release,³ the AASM announced the launch of Sleep is Good Medicine, a national campaign to expand public education about sleep’s relationship to health. The program will show individuals the importance of healthy sleep habits to enhance one’s immunity, decrease stress, and lower the risk of chronic conditions such as diabetes and hypertension.

“This campaign will support the AASM vision that sleep is recognized as essential to health. Sleep is as important as nutrition and exercise for our health and well-being,” stated Dr Raman Malhotra, board-certified sleep medicine physician, and professor, department of neurology, Washington University School of Medicine, St Louis.

Conclusion

Quality sleep has an integral role in overall health and well-being, and the significance of sleep quality should never be underestimated. Clinicians should inquire if patients are having sleep issues, including chronic insomnia, and sleep disturbances, such as fragmented sleep. Patients should also be evaluated for signs of common sleep disorders including sleep apnea, restless legs syndrome, and narcolepsy and should be encouraged to seek further evaluation and care from a sleep specialist.  

Valuable patient educator and provider resources on sleep can be found at the American Sleep Association website and the National Sleep Foundation website.

References

1. What are sleep deprivation and deficiency? National Heart, Lung, and Blood Institute. Updated March 24, 2022. Accessed June 14, 2022. https://www.nhlbi.nih.gov/health/sleep-deprivation
2. 1 in 3 Americans don’t get enough sleep: A good night’s sleep is critical for good health. News release. Centers for Disease Control and Prevention; February 16, 2016. Accessed June 14, 2022. https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html
3. American Academy of Sleep Medicine launches ‘Sleep is Good Medicine’ campaign to help Americans get more out of sleep. American Academy of Sleep Medicine; June 6, 2022. Accessed June 14, 2022. https://aasm.org/american-academy-of-sleep-medicine-launches-sleep-is-good-medicine-campaign-to-help-americans-get-more-out-of-sleep/ 
4. Johnson A, Goel N, Casale C, Volgman A, Aggarwal N. Characterization of the prevalence of sleep disturbances in cardiovascular and neurological patients from the Rush Heart Center for Women. Abstract presented at: SLEEP 2022; June 4-8, 2022; Charlotte, NC.
5. Carneiro-Barrera A, Amaro-Gahete FJ, Guillén-Riquelme A, et al. Effect of an interdisciplinary weight loss and lifestyle intervention on obstructive sleep apnea severity: The INTERAPNEA randomized clinical trial. JAMA Netw Open. 2022;5(4):e228212. doi:10.1001/jamanetworkopen.2022.8212
6. Baugh A, Buhr RG, Quibrera P, et al. Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity. Sleep. Published online June 6, 2022. doi:10.1093/sleep/zsac107
7. Scott H, Lechat B, Reynolds A, et al. Sleep irregularity is associated with increased risk of hypertension: data from over two million nights. Abstract presented at: SLEEP 2022; June 4-8, 2022; Charlotte, NC.
8. Narcisse MR, Bernard M, Briggs A, et al. COVID-19 is associated with shorter sleep duration among American adults. Abstract presented at: SLEEP 2022; June 4-8, 2022; Charlotte, NC.
9. National Sleep Foundation’s 2022 Sleep In America® poll: Americans can do more during the day and night to improve sleep. National Sleep Foundation; March 13, 2022. Accessed June 14, 2022. https://www.thensf.org/national-sleep-foundations-2022-sleep-in-america-poll-americans-can-do-more-during-the-day-and-night-to-improve-sleep/