Editorial Sleep Disturbances

Approximately 90% of the population-attributable risk for coronary artery disease has been estimated to relate to 9 potentially modifiable risk factors, including tobacco smoking, overweight, dyslipidemia, hypertension, physical inactivity, poor diet, and psychosocial factors.1 Accordingly, published guidelines for primary and secondary cardiovascular disease prevention support aggressive risk factor modification.2 Although sleep disturbances have not been identified as specific targets in current cardiovascular prevention guidelines, research over the last decade provides increasing evidence that poor sleep and sleep disorders significantly contribute to the development of heart disease. Furthermore, because of their prevalence, sleep disturbances ranging from sleep apnea to sleep curtailment may serve as important novel targets for cardiovascular disease risk reduction. This issue’s report by Laugsand and colleagues linking insomnia symptoms and subsequent risk of acute myocardial infarction (AMI) over an 11-year time period in a sample of 50 000 individuals from Nord Trondelag County, Norway, provides further evidence supporting the importance of sleep disorders in the pathogenesis of coronary artery disease.3 Use of a simple question, “Have you had difficulties falling asleep in the last month?” identified a group of individuals at a significantly increased relative risk of experiencing a subsequent AMI. Even after considering a comprehensive set of potential confounders such as age, depression, anxiety, and physical activity, the 3% of the sample who reported that this symptom occurred “almost every night” experienced a 40% to 50% increased multivariate adjusted hazard ratio for AMI. Further, there was a continuous graded relationship between increasing sleep disturbance and increased risk of AMI.