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Circulation: Trajectories of Sleep Over Midlife and Incident Cardiovascular Disease Events in the Study of Women’s Health Across the Nation

February 19, 2024

This article was originally published on the University of Pittsburgh Department of Psychiatry's website.

Cardiovascular disease and poor sleep are both major health issues for women, with cardiovascular disease representing the leading cause of death in women. Poor sleep quality, elevated insomnia symptoms, and extreme sleep duration (short or long) are all associated with elevated cardiovascular disease risk. Midlife (here defined as 40-65 years old) is often a time of accelerated vascular risk, as well as a time when sleep problems become evident.

Investigators including Rebecca Thurston, PhD (Pittsburgh Foundation Chair in Women's Health and Dementia and Professor of Psychiatry, Clinical and Translational Science, Epidemiology and Psychology), from the University of Pittsburgh, tested how the trajectories of insomnia symptoms and sleep duration over midlife were related to subsequent incident cardiovascular disease events, such as heart attacks, strokes, heart failure, or cardiovascular disease mortality. The scientists analyzed data from participants in the Study of Women’s Health Across the Nation (SWAN), 2,517 women whose sleep was assessed up to 16 times over 22 years during midlife. 

At each of the 16 visits, participants reported the frequency of sleep problems over the previous two weeks, and reported the occurrence of cardiovascular disease events. At four of the follow-up assessments, participants reported their typical daily sleep duration over the preceding month.

The investigators found that persistently high insomnia symptoms—experienced by almost a quarter of the women studied over the two decades—were associated with 70% increased risk of a cardiovascular disease event. Further, women who had persistently high insomnia that was also accompanied by short sleep had an even greater increased risk (75%) of cardiovascular disease events. These associations were observed even after accounting for demographic factors and cardiovascular disease risk factors. The study was recently published in a special issue of Circulation devoted to women’s heart health.

“These findings underscore both the prevalence of insufficient sleep at midlife in women as well as the importance of insomnia to women’s cardiovascular health over midlife. These data further suggest the potential value of treating insomnia to support women’s heart health,” said Dr. Thurston, the study’s corresponding author.

Trajectories of Sleep Over Midlife and Incident Cardiovascular Disease Events in the Study of Women’s Health Across the Nation. Thurston RC, Chang Y, Kline CE, Swanson LM, El Khoudary SR, Jackson EA, Derby CA. Circulation Volume 149, Issue 7, 13 February 2024; Pages 545-555.