Association of actigraphy-measured sleep parameters and subclinical atherosclerotic burden: the PESA study Fernando Domínguez, MD, PhD ; Valentín Fuster, MD, PhD ; Juan Miguel Fernández-Alvira, PhD; Leticia Fernández-Friera, MD, PhD; Beatriz López Melgar, MD, PhD; Ruth Blanco-Rojo, PhD; Antonio Fernández-Ortiz, MD, PhD; Pablo García-Pavía, MD, PhD ; Javier Sanz, MD; Jose M Mendiguren, MD; Borja Ibañez, MD, PhD; Héctor Bueno, MD, PhD; Enrique Lara-Pezzi, PhD; José M. Ordovás, PhD Sources of funding : The PESA study is co-funded equally by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain, and Banco Santander, Madrid, Spain. The study also receives funding from the Institute of Health Carlos III (PI15/02019) and the European Regional Development Fund (ERDF). The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MEIC) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (MEIC award SEV-2015-0505).
Conclusions • Sleeping less than six hours or waking up several times in the night (fragmented sleep) is associated with an increased risk of asymptomatic atherosclerosis. • Prevalence of metabolic syndrome is directly associated with abnormal sleep patterns, which depicts a population with unhealthier habits.
Background Some evidence suggests that short and long sleep duration, as well as poor quality of sleep, are associated with an increased risk of cardiovascular disease However, large studies evaluating objectively measured sleep parameters and subclinical atherosclerosis assessed by multimodality imaging approach are still lacking. ARE POOR SLEEP HABITS LINKED TO THE HARDENING OF THE ARTERIES?
Purpose and key points about methods Main objective: PESA baseline cohort = 4184 To evaluate the association of actigraphy- measured sleep parameters with asymptomatic atherosclerosis in a large Sleep apnea diagnosis No actigraphic recording n=133 population included in the PESA study. n= 77 2488 men (62.6%) Sleep duration groups : VSSD (<6h): n= 1071 SSD (6-7h): n= 1521 n= 3974 Clinical characteristics RSD (7-8h, reference): n= 1222 LSD (>8h): n=160 Sleep fragmentation groups : n=774-787 in each quintile Quintile 5 (more fragmented) Quintile 1 (less fragmented, reference ) 3D VUS CAC score Subclinical non-coronary Subclinical coronary n= 3899 n= 3804 atherosclerosis calcification
Results Sleep is not adequately quantified with subjective questionnaires
í í á á ó á í í ñ é é á é í ó é í ó ± Results ü ü ü ü SLEEP� DURATION (Reference:� 7-8h) ü NUMBER� OF� TERRITORIES� AFFECTED� (1-4) NONCORONARY� PLAQUE� BURDEN� (mm 3 ) � � � � � � � � � � � � � � Number� of� territories� affected� (1-4) � � � � � � � � � � � Noncoronary� plaque� burden� � (mm 3 ) ü p� value p� value OR (CI� 95%) OR (CI� 95%) ü 1.21� (1.02-1.45) 0.03 1.27� (1.06-1.52) 0.008 <6h <6h <6H <6H 1.14� (0.93-1.41) 0.21 1.21� (0.98-1.49) 0.08 Men� <6h Men� <6h MEN<6H MEN<6H 1.38� (1.00-1.93) 0.053 duration 1.48� (1.06-2.07) 0.02 duration Women� <6h Women� <6h WOMEN<6H WOMEN<6H 1.07� (0.9-1.26) 0.40 Very� short� sleep� 1.10� (0.94-1.30) 0.25 6-7h 6-7h 6-7H 6-7H duration 1.04 (0.85-1.27) 0.71 1.13 (0.93-1.38) 0.23 Men� 6-7h Men� 6-7h MEN� 6-7H MEN� 6-7H Sleep� Sleep� 1.12� (0.84-1.48) 0.44 1.01� (0.76-1.36) 0.90 Women� 6-7h Women� 6-7h WOMEN� 6-7H WOMEN� 6-7H 1.13� (0.79-1.13) 0.50 1.31� (0.92-1.85) 0.13 >8h >8h >8H >8H 0.85� (0.50-1.35) 0.44 0.96� (0.59-1.56) 0.87 Men� >8h Men� >8h MEN>8H MEN>8H 1.65� (1.01-2.72) 0.05 1.83� (1.12-3.01) 0.02 Women� >8h Women� >8h WOMEN>8H WOMEN>8H 1 1 0 0 . 1 1 0 . 1 0 1 Odds� ratio Odds� ratio SLEEP� FRAGMENTATION <6h of sleep: more atherosclerosis ü ü
í í á á ó á í í ñ é é á é í ó é í ó ± ü ü ü ü ü ü ü Results Odds� ratio Odds� ratio SLEEP� FRAGMENTATION (Reference:� Quintile� 1,� less� fragmented� sleep) � � � � � � � � � � � � � � � Noncoronary � plaque� burden (mm 3 ) NONCORONARY� PLAQUE� BURDEN� � � � � � � � � � � � � � � � � Number� NUMBER� of� OF� territories� TERRITORIES� affected� AFFECTED� (1-4) (1-4) p� value p� value OR (CI� 95%) OR (CI� 95%) 5th� Quintile 5 TH QUINTILE 1.23 (1.00-1.52) 0.048 5 TH QUINTILE 5th� Quintile 1.34 (1.09-1.64) 0.006 Men� 5th� Q Men� 5th� Q 1.29� (1.00-1.66) 0.048 MEN� 5TH� Q 1.43� (1.12-1.85) 0.005 MEN� 5TH� Q fragmentation Women� 5th� Q Women� 5th� Q 1.15� (0.79-1.67) 0.47 WOMEN� 5TH� Q WOMEN� 5TH� Q 1.18� (0.81-1.71) 0.38 4th� Quintile 4 TH QUINTILE 4th� Quintile 4 TH QUINTILE 0.90(0.73-1.11) 0.33 0.95(0.77-1.74) 0.65 4 TH Q Men� 4 TH Q 4th� Q Men� 4th� Q MEN� MEN� 1.01� (0.78-1.30) 0.95 1.10� (0.84-1.42) 0.48 4 TH Q Women� 4 TH Q 4th� Q Women� 4th� Q WOMEN� WOMEN� 0.70� (0.48-1.02) 0.07 0.70� (0.48-1.02) 0.07 3 RD QUINTILE 3 RD QUINTILE 3rd� Quintile 3rd� Quintile 0.88� (0.71-1.08) 0.23 0.90� (0.73-1.10) 0.31 3 RD Q 3 RD Q Men� 3rd� Q Men� 3rd� Q MEN� MEN� 0.96� (0.74-1.24) 0.76 1.01� (0.78-1.30) 0.96 Sleep� 3 RD Q 3 RD Q Women� 3rd� Q Women� WOMEN� 3rd� Q WOMEN� 0.73� (0.59-1.06) 0.10 0.71� (0.49-1.03) 0.07 2 ND QUINTILE 2 ND QUINTILE 2nd� Quintile 2nd� Quintile 0.88� (0.72-1.09) 0.25 0.94� (0.76-1.16) 0.54 2 ND Q 2 ND Q MEN� Men� 2nd� Q Men� MEN� 2nd� Q 0.87� (0.67-113.) 0.29 0.93� (0.72-1.21) 0.60 2 ND Q 2 ND Q Women� 2nd� Q WOMEN� Women� WOMEN� 2nd� Q 0.92� (0.65-1.31) 0.64 0.97� (0.68-1.36) 0.84 ü 0 . 1 1 10 1 0 1 0 . 1 Odds� ratio Odds� ratio ü Figure� 3 Forest� plots� showing� the� odds� More fragmented sleep: more arterial territories with atherosclerosis ratios� and� confidence� intervals� of� total� plaque� burden� measured� by� 3D� echo� (carotid� and� femoral� territories)� and� affected� territories� in� the� different� groups�
Key messages • Sleep is an important factor influencing cardiovascular health both short and fragmented sleep could have a role as markers of cardiovascular risk . • A good night´s sleep is important for cardiovascular health Take steps to achieve good sleep hygiene: physical activity, avoid coffee / fatty foods before bedtime …
Acknowledgements STEERING COMMITTEE Valentín Fuster (Chairman) PESA Principal Investigator Antonio Fernández-Ortiz PESA Scientific Coordinator José María Mendiguren Bank of Santander Leader Juan Miguel Fernández-Alvira Borja Ibáñez CNIC Director Clínical Res Dpt Vicente Andrés CNIC Director Basic Res Dpt Leticia Fernández-Friera Alberto Sanz CNIC Managing Director Beatriz López Melgar DEDICATED COMMITTEES Pablo García-Pavía Javier Sanz Basic & Advance Imaging Ruth Blanco-Rojo José María Ordovás Systems Biology & Lifestyle Enrique Lara Systems Biology & Biomarkers Héctor Bueno Clinical Events Adjudication José Manuel García-Ruiz Statistics & Data Management Angel Ciprés PESA Project Manager
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