title: Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women.
abstract: Midlife, which encompasses the menopause transition in women, can be a time of disrupted sleep and accelerated atherosclerosis accumulation. Short or poor sleep quality has been associated with cardiovascular disease (CVD) risk; few studies have investigated relations among midlife women. We tested whether shorter actigraphy sleep time or poorer subjective sleep quality was associated with carotid atherosclerosis among midlife women.
  
  
  
  Two hundred fifty-six peri- and postmenopausal women aged 40-60 years completed 3 days of wrist actigraphy, hot flash monitoring, questionnaires (Pittsburgh Sleep Quality Index [PSQI], Berlin), a blood draw, and carotid ultrasound [intima media thickness (IMT), plaque]. Associations of objective (actigraphy) and subjective (PSQI) sleep with IMT/plaque were tested in regression models (covariates: age, race, education, body mass index, blood pressure, lipids, insulin resistance, medications, snoring, depressive symptoms, sleep hot flashes, and estradiol).
  
  
  
  Shorter objective sleep time was associated with higher odds of carotid plaque (for each hour shorter sleep, plaque score ≥ 2, odds ratio (OR) [95% confidence interval, CI] = 1.58 [1.11-2.27], p = .01; plaque score = 1, OR [95% CI] = 0.95 [0.68-1.32], p = .75, vs. no plaque, multivariable). Poorer subjective sleep quality was associated with higher mean IMT [β, b (standard error, SE) = 0.004 (0.002), p = .03], maximal IMT [b (SE) = 0.009 (0.003), p = .005], and plaque [plaque score ≥ 2, OR (95% CI) = 1.23 (1.09-1.40), p = .001; score = 1, OR (95% CI) = 1.06 (0.93-1.21), p = .37, vs. no plaque] in multivariable models. Findings persisted additionally adjusting for sleep hot flashes and estradiol.
  
  
  
  Shorter actigraphy-assessed sleep time and poorer subjective sleep quality were associated with increased carotid atherosclerosis among midlife women. Associations persisted adjusting for CVD risk factors, hot flashes, and estradiol.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.|Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.|Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.affiliation: Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
authors.forename: Yuefang
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
authors.forename: J Richard
authors.initials: JR
authors.lastname: Jennings
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.|Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260.
authors.forename: Martica H
authors.initials: MH
authors.lastname: Hall
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO 80238.
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.|Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.|Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D056044:Actigraphy / Q000379:methods; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D005260:Female; D019584:Hot Flashes / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology*; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: cardiovascular disease.; intima media thickness; menopause; sleep