Association of Insomnia and Short Sleep Duration With Atherosclerosis Risk in the Elderly

BACKGROUND Short sleep duration is associated with an increased risk of cardiovascular disease and all-cause mortality, although a relationship with atherosclerosis in the elderly remains unclear. METHODS Eighty-six volunteers aged 65 years (mean, 73.6 +/- 4.9 years) were evaluated for insomnia. Total sleep time (TST) and sleep efficiency were measured by actigraphy. Subjective symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI). Atherosclerosis was evaluated using ultrasonographic measurements of carotid intima media thickness (IMT). RESULTS IMT was significantly greater and sleep efficiency was significantly lower in subjects with TST <= 5 h than those with TST >7 h (1.3 +/- 0.5 vs. 0.9 +/- 0.3 mm; P = 0.009; 91.0 +/- 6.0 vs. 81.6 +/- 11.3%, P = 0.03, respectively). IMT was also significantly greater in the insomnia group than the noninsomnia group (1.3 +/- 0.5 vs. 1.1 +/- 0.4 mm; P = 0.03). IMT was significantly correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and 1ST (SBP: r = 0.49, P < 0.0001; DBP:r = 0.33, P = 0.0021; TST:r = -0.28, P = 0.010). Multiple regression analysis revealed that SBP, TST, and the PSQI were significant contributing factors for increased IMT (SBP:coefficient beta = 0.56, P = 0.0001; TST: coefficient beta = -0.32, P = 0.005; PSQI: coefficient beta = 0.22, P = 0.05). CONCLUSIONS High blood pressure, short sleep duration (<= 5 h), poor sleep, and insomnia were associated with atherosclerosis risk leading to cardiovascular disease in the elderly.