Highlights
- •Cardiovascular (CV) and sleep-related disorders have high prevalence.
- •Sleep-related disorders are associated with increased CV disease risk.
- •Sleep-related disorders entail increased nighttime CV activity.
- •Increased nighttime CV activity increases CV disease risk.
- •Increased nighttime CV activity may thus link sleep disorders to CV disease risk.
Abstract
Cardiovascular disease (CVD) represents the first cause of death globally. The nighttime
is generally a period of relative protection from CVD events such as myocardial infarction,
sudden cardiac death, and stroke, at least compared to the early morning period. The
nighttime also generally entails lower values of arterial blood pressure (ABP) and
heart rate (HR) and higher cardiac parasympathetic modulation. These day-night cardiovascular
rhythms are ultimately driven by circadian molecular oscillators in the hypothalamic
suprachiasmatic nucleus and in peripheral cells, including those in the heart, blood
vessels, and kidneys. The wake-sleep states are intermediate mechanisms of circadian
cardiovascular regulation, with non-REM sleep decreasing ABP and HR and increasing
cardiac parasympathetic modulation at the beginning of the night. Obstructive sleep
apnea, insomnia, and the restless legs syndrome have high prevalence in the general
population and may increase nighttime cardiovascular activity and CVD risk. CVD risk
is better predicted by ABP values during nighttime sleep than during daytime wakefulness.
Higher nighttime values of ABP and HR increase cardiac work and vessel wall stress.
During the night, circadian rhythms may enhance cardiac responses to hypertrophic
stimuli, increase vascular smooth muscle Rho kinase activity and contractility, decrease
endothelial nitric oxide production and vascular responses to vasodilators, and increase
circulating monocytes with the potential to infiltrate atherosclerotic plaques. Together,
these factors configure a “perfect storm” scenario that may make increased cardiovascular
activity during the night a final common mechanism linking sleep disorders to CVD
risk.
Keywords
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Article info
Publication history
Published online: February 22, 2019
Accepted:
February 21,
2019
Received in revised form:
February 16,
2019
Received:
January 12,
2019
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© 2019 Elsevier B.V. All rights reserved.
