title: Endothelial function and sleep: associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep.
abstract: Endothelial function typically precedes clinical manifestations of cardiovascular disease and provides a potential mechanism for the associations observed between cardiovascular disease and sleep quality. This study examined how subjective and objective indicators of sleep quality relate to endothelial function, as measured by brachial artery flow-mediated dilation (FMD). In a clinical research centre, 100 non-shift working adults (mean age: 36 years) completed FMD testing and the Pittsburgh Sleep Quality Index, along with a polysomnography assessment to obtain the following measures: slow wave sleep, percentage rapid eye movement (REM) sleep, REM sleep latency, total arousal index, total sleep time, wake after sleep onset, sleep efficiency and apnea-hypopnea index. Bivariate correlations and follow-up multiple regressions examined how FMD related to subjective (i.e., Pittsburgh Sleep Quality Index scores) and objective (i.e., polysomnography-derived) indicators of sleep quality. After FMD showed bivariate correlations with Pittsburgh Sleep Quality Index scores, percentage REM sleep and REM latency, further examination with separate regression models indicated that these associations remained significant after adjustments for sex, age, race, hypertension, body mass index, apnea-hypopnea index, smoking and income (Ps < 0.05). Specifically, as FMD decreased, scores on the Pittsburgh Sleep Quality Index increased (indicating decreased subjective sleep quality) and percentage REM sleep decreased, while REM sleep latency increased (Ps < 0.05). Poorer subjective sleep quality and adverse changes in REM sleep were associated with diminished vasodilation, which could link sleep disturbances to cardiovascular disease.
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Cooper
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Milos S
authors.initials: MS
authors.lastname: Milic
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: José S
authors.initials: JS
authors.lastname: Loredo
authors.forename: Roland
authors.initials: R
authors.lastname: Von Känel
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001916:Brachial Artery / Q000473:pathology / Q000502:physiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010465:Perception / Q000502:physiology*; D017286:Polysomnography; D012039:Regional Blood Flow / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D012895:Sleep, REM / Q000502:physiology*; D012907:Smoking; D012923:Social Class; D013315:Stress, Psychological; D014664:Vasodilation / Q000502:physiology*; D055815:Young Adult
keywords: endothelial function; polysomnography; sleep; subjective sleep quality; vasodilation
references.citation: Am J Respir Crit Care Med. 2010 Dec 15;182(12):1540-5
references.pmid: 20656942
references.citation: Endothelium. 2006 Nov-Dec;13(6):423-9
references.pmid: 17169774
references.citation: Occup Med (Lond). 2011 Mar;61(2):78-89
references.pmid: 21355031
references.citation: Horm Metab Res. 2008 Sep;40(9):635-9
references.pmid: 18792875
references.citation: Diabetes Care. 2007 Apr;30(4):939-45
references.pmid: 17392554
references.citation: J Health Soc Behav. 1983 Dec;24(4):385-96
references.pmid: 6668417
references.citation: Lancet. 1992 Nov 7;340(8828):1111-5
references.pmid: 1359209
references.citation: Sleep Med Rev. 2012 Jun;16(3):265-79
references.pmid: 22406306
references.citation: Sleep Breath. 2008 Nov;12(4):331-7
references.pmid: 18398629
references.citation: Sleep. 2007 Jun;30(6):729-35
references.pmid: 17580594
references.citation: Sleep. 2010 Dec;33(12):1589-603
references.pmid: 21120121
references.citation: Pflugers Arch. 2011 Dec;462(6):779-94
references.pmid: 21947555
references.citation: J Clin Endocrinol Metab. 1998 May;83(5):1573-9
references.pmid: 9589658
references.citation: Chest. 2007 Mar;131(3):733-739
references.pmid: 17356087
references.citation: Circulation. 2007 May 8;115(18):2390-7
references.pmid: 17452608
references.citation: J Am Coll Cardiol. 2002 Jan 16;39(2):257-65
references.pmid: 11788217
references.citation: Psychiatry Res. 1989 May;28(2):193-213
references.pmid: 2748771
references.citation: Curr Probl Cardiol. 2005 Dec;30(12):625-62
references.pmid: 16301095
references.citation: Chest. 2005 Jun;127(6):2254-63
references.pmid: 15947345
references.citation: J Hypertens. 1999 Jan;17(1):61-6
references.pmid: 10100095
references.citation: Med Sci Monit. 2012 Dec;18(12):CR747-51
references.pmid: 23197238
references.citation: Am J Cardiol. 2004 Apr 1;93(7):947-9
references.pmid: 15050508
references.citation: Psychosom Med. 2008 May;70(4):410-6
references.pmid: 18480189
references.citation: Scand J Work Environ Health. 2006 Dec;32(6):493-501
references.pmid: 17173205
references.citation: Sleep. 2008 Aug;31(8):1071-8
references.pmid: 18714778
references.citation: Gerontology. 2010;56(1):41-50
references.pmid: 19955705
references.citation: Sleep. 2011 Nov 01;34(11):1487-92
references.pmid: 22043119
references.citation: Sleep. 2010 Feb;33(2):177-84
references.pmid: 20175401
references.citation: Arch Med Res. 2006 May;37(4):552-5
references.pmid: 16624658