Sleep & dyslipidaemia
| Educator
6th Sep, 2022Quick read

 

Dyslipidaemia, or abnormal serum lipid profiles, is a significant risk factor for cardiovascular disease (CVD) and increases the morbidity and mortality of CVD (1,2,3). Dyslipidaemia is characterised by elevated total cholesterol (TC) or low-density lipoprotein (LDL) cholesterol levels or low levels of high-density lipoprotein (HDL) cholesterol.

Various risk factors have been confirmed to be related to dyslipidaemia, including low cardiorespiratory fitness, obesity, physical inactivity, type 2 diabetes mellitus, smoking, alcohol, age and gender (4,5,6). In addition, sleep also plays an important role in the progression of dyslipidaemia (7,8,9).

Sleep is a vital physiological activity for humans, who spend about one-third of their time sleeping. Consequently, the associations between sleep duration and human health outcomes have received increasing attention (10,11). Several studies have demonstrated that sleep duration is associated with obesity (12,13), hypertension (14), diabetes (15), metabolic syndrome (16) and CVD (17,18,19). In addition to physical illnesses, sleep duration is also associated with psychological disorders such as stress perception and the incidence of depressive symptoms (20).

The association between sleep duration and dyslipidaemia has proven to be contradictory, with some studies finding short or long-duration sleep associations (9,21) and others finding no association (22,23). This discrepancy might be explained by inconsistencies in the study population, the classification of sleep duration and the definition of dyslipidaemia.

A recent population-based cross-sectional epidemiologic study of 60,283 adults (>18 years) in China found that both shorter and longer sleep durations were associated with abnormal serum lipid profiles in men and women (24).

Previous studies found that shorter and longer sleep duration was associated with dyslipidaemia in women but not men (25,26). The current study found differences between different elements of dyslipidaemia between men and women, but the effects on overall dyslipidaemia affected both males and females. Both short and long sleep duration was associated with dyslipidaemia, high TC, and high LDL cholesterol in men and women. Both short and long sleep duration was associated with elevated triglycerides (TG) in men, while short sleep duration was associated with high TG in women. Short and long sleep duration were associated with low HDL cholesterol in men but not women.

Some mechanisms explaining the differences between the effects of sleep duration in men and women:

  • Different mechanisms of sleep duration affect the regulation of food intake between men and women. For example, sleep duration has been shown to affect total ghrelin  levels in men but not women, and glucagon-like peptide 1(GLP-1) levels in women but not in men (27).
  • The major sex hormones, testosterone in men and oestrogen and progesterone in women, have different mechanisms for regulating sleep duration and quality (28). Sleep disturbances induce changes in the gonadal endocrine axis, leading to lower circulating levels of testosterone. In addition, female reproductive milestones such as menarche, pregnancy, breastfeeding and menopause have profound implications for endogenous steroid exposure (29,30) with consequent effects on sleep regulation.
  • Advanced glycosylation end products  (AGEs) significantly increase as a result of chronic sleep deprivation. AGEs can induce endothelial damage through the apoptosis of endothelial cells. Gastrin has a protective effect on this process; however, males and females respond differently to gastrin and AGEs after sleep deprivation (16).

 

Conclusion

It is well known that sufficient good quality sleep is vital for maintaining optimal health, allowing the human body to restore function and energy, and reducing disease risks (31,32,33). According to the Australian Sleep Health Foundation, adults typically require 7-9 hours of sleep per night, with 6-10 hours being appropriate for some people (34). However, with the rapid development of the economy and modernisation, people face problems induced by the fast pace of life and high social pressure, which leads to anxiety, depression, and other emotional disorders, causing insomnia and poor sleep quality (35).

While this study is cross-sectional, which cannot infer a causal relationship between sleep duration and abnormal serum lipids, it adds to the growing body of evidence indicating that excessive and insufficient sleep duration is associated with abnormal serum lipids in men and women. Furthermore, sleep quality is also associated with abnormal serum lipids (36,37). Therefore, improving sleep quality and achieving sufficient sleep time is an important clinical objective for maintaining personal health and reducing CVD risk.

References
1Fodor G. Primary prevention of CVD: treating dyslipidaemia. BMJ Clin Evid. 2010 Dec 1;2010:0215.
2Liang Y, Vetrano DL, Qiu C. Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: a population-based study. BMC Geriatr. 2017 Dec 28;17(1):294.
3Jin Q, Yang N, Dai J, Zhao Y, Zhang X, Yin J, et al. Association of Sleep Duration With All-Cause and Cardiovascular Mortality: A Prospective Cohort Study. Front Public Health. 2022;10:880276.
4Joffres M, Shields M, Tremblay MS, Gorber SC. Dyslipidemia Prevalence, Treatment, Control, and Awareness in the Canadian Health Measures Survey. Can J Public Health. 2013 May;104(3):e252–7.
5Halcox JP, Banegas JR, Roy C, Dallongeville J, De Backer G, Guallar E, et al. Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovasc Disord. 2017 Jun 17;17(1):160.
6Ohta T, Nagashima J, Sasai H, Ishii N. Relationship of Cardiorespiratory Fitness and Body Mass Index with the Incidence of Dyslipidemia among Japanese Women: A Cohort Study. Int J Environ Res Public Health. 2019 Dec;16(23):4647.
7Zheng Y, Wang A, Pan C, Lu J, Dou J, Lu Z, et al. Impact of night sleep duration on glycemic and triglyceride levels in Chinese with different glycemic status. J Diabetes. 2015 Jan;7(1):24–30.
8Lin P, Chang KT, Lin YA, Tzeng IS, Chuang HH, Chen JY. Association between self-reported sleep duration and serum lipid profile in a middle-aged and elderly population in Taiwan: a community-based, cross-sectional study. BMJ Open. 2017 Oct 30;7(10):e015964.
9Song Q, Liu X, Zhou W, Wu S, Wang X. Night sleep duration and risk of each lipid profile abnormality in a Chinese population: a prospective cohort study. Lipids Health Dis. 2020 Aug 15;19(1):185.
10Covassin N, Singh P. Sleep Duration and Cardiovascular Disease Risk: Epidemiologic and Experimental Evidence. Sleep Med Clin. 2016 Mar;11(1):81–9.
11Zhou L, Yu K, Yang L, Wang H, Xiao Y, Qiu G, et al. Sleep duration, midday napping, and sleep quality and incident stroke: The Dongfeng-Tongji cohort. Neurology. 2020 Jan 28;94(4):e345–56.
12Lee JH, Cho J. Sleep and Obesity. Sleep Med Clin. 2022 Mar;17(1):111–6.
13Antza C, Kostopoulos G, Mostafa S, Nirantharakumar K, Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol. 2021 Dec 13;252(2):125–41.
14Han B, Chen WZ, Li YC, Chen J, Zeng ZQ. Sleep and hypertension. Sleep Breath. 2020;24(1):351–6.
15Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2015 Mar;38(3):529–37.
16Smiley A, Wolter S, Nissan D. Mechanisms of Association of Sleep and Metabolic Syndrome. J Med - Clin Res & Rev. 2019 Jun 30;3(3):1–9.
17Drager LF, Santos RB, Silva WA, Parise BK, Giatti S, Aielo AN, et al. OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults: The ELSA-Brasil Study. Chest. 2019 Jun;155(6):1190–8.
18Clark AJ, Salo P, Lange T, Jennum P, Virtanen M, Pentti J, et al. Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study. Sleep. 2016 Sep 1;39(9):1709–18.
19Wang Z, Yang W, Li X, Qi X, Pan KY, Xu W. Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study. J Am Heart Assoc. 2022 Aug 2;11(15):e025969.
20Seow LSE, Tan XW, Chong SA, Vaingankar JA, Abdin E, Shafie S, et al. Independent and combined associations of sleep duration and sleep quality with common physical and mental disorders: Results from a multi-ethnic population-based study. PLoS One. 2020;15(7):e0235816.
21Kinuhata S, Hayashi T, Sato KK, Uehara S, Oue K, Endo G, et al. Sleep duration and the risk of future lipid profile abnormalities in middle-aged men: the Kansai Healthcare Study. Sleep Med. 2014 Nov;15(11):1379–85.
22Jike M, Itani O, Watanabe N, Buysse DJ, Kaneita Y. Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression. Sleep Med Rev. 2018 Jun;39:25–36.
23Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017 Apr;32:246–56.
24Du J, Chen Y, Zhou N, Song Y, Wang W, Hong X. Associations between self-reported sleep duration and abnormal serum lipids in eastern China: a population-based cross-sectional survey. Sleep Med. 2022 Jul;95:1–8.
25Zhan Y, Chen R, Yu J. Sleep duration and abnormal serum lipids: the China Health and Nutrition Survey. Sleep Med. 2014 Jul;15(7):833–9.
26Kaneita Y, Uchiyama M, Yoshiike N, Ohida T. Associations of usual sleep duration with serum lipid and lipoprotein levels. Sleep. 2008 May;31(5):645–52.
27St-Onge MP, O’Keeffe M, Roberts AL, RoyChoudhury A, Laferrère B. Short sleep duration, glucose dysregulation and hormonal regulation of appetite in men and women. Sleep. 2012 Nov 1;35(11):1503–10.
28Trenell MI, Marshall NS, Rogers NL. Sleep and metabolic control: waking to a problem? Clin Exp Pharmacol Physiol. 2007 Feb;34(1–2):1–9.
29Lord C, Sekerovic Z, Carrier J. Sleep regulation and sex hormones exposure in men and women across adulthood. Pathol Biol (Paris). 2014 Oct;62(5):302–10.
30Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016 Feb 19;371(1688):20150110.
31Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021 Dec;60:101556.
32Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015 Jan 3;66:143–72.
33McHill AW, Wright KP. Role of sleep and circadian disruption on energy expenditure and in metabolic predisposition to human obesity and metabolic disease. Obes Rev. 2017 Feb;18 Suppl 1:15–24.
34Sleep Health Foundation. How much sleep do you really need? [Internet]. 2016 [cited 2022 Aug 11]. Available from: https://www.sleephealthfoundation.org.au/how-much-sleep-do-you-really-need.html
35Simon EB, Vallat R, Barnes CM, Walker MP. Sleep Loss and the Socio-Emotional Brain. Trends Cogn Sci. 2020 Jun;24(6):435–50.
36Aimo A, Giannoni A, Vergaro G, Emdin M. Longer sleep duration and poor sleep quality as risk factors for hyperlipidaemia. Eur J Prev Cardiol. 2019 Aug;26(12):1285–7.
37Geovanini GR, Lorenzi-Filho G, de Paula LK, Oliveira CM, de Oliveira Alvim R, Beijamini F, et al. Poor sleep quality and lipid profile in a rural cohort (The Baependi Heart Study). Sleep Med. 2019 May;57:30–5.