Sleep disorders as contributors to cardiometabolic disease in adult populations
DOI:
https://doi.org/10.59652/56fsav07Keywords:
Sleep disorders, insomnia, obstructive sleep apnoea, cardiometabolic disease, hypertension, type 2 diabetes, obesity, circadian disruption, shift work, clinical screeningAbstract
Sleep disorders and disturbed sleep patterns are increasingly recognised as contributors to cardiometabolic disease in adults. The evidence is strongest for short sleep duration, obstructive sleep apnoea, insomnia with objective or perceived sleep loss, and circadian disruption related to shift work or irregular sleep timing. These exposures are associated with hypertension, type 2 diabetes, obesity, coronary heart disease, stroke, heart failure, atrial fibrillation, impaired glucose regulation, and increased cardiovascular risk. This literature review examines the contribution of insomnia, obstructive sleep apnoea, insufficient sleep, long sleep duration, circadian misalignment, and shift work to adult cardiometabolic disease. PubMed-indexed systematic reviews, meta-analyses, cohort studies, clinical practice guidelines, mechanistic studies, and randomized trials were reviewed. The epidemiological evidence shows consistent associations between short sleep duration and incident diabetes, hypertension, cardiovascular disease, coronary heart disease, and obesity. Long sleep duration is also associated with increased risk of several outcomes, although causality is less certain and reverse causation is more likely. Obstructive sleep apnoea is common, frequently underdiagnosed, and strongly enriched among patients with obesity, resistant hypertension, heart failure, atrial fibrillation, and type 2 diabetes. Continuous positive airway pressure improves sleepiness and quality of life and may reduce blood pressure most clearly in patients with uncontrolled or resistant hypertension, but its effect on major cardiovascular events is inconsistent in intention-to-treat trials. Circadian disruption adds a separate risk pathway through misalignment of sleep, feeding, endocrine rhythms, blood pressure regulation, and glucose tolerance. Clinical screening should therefore move beyond asking whether a patient sleeps enough. Adults with cardiometabolic disease should be assessed for sleep duration, insomnia symptoms, snoring, witnessed apnoea, daytime sleepiness, resistant hypertension, shift work, and irregular sleep timing. Sleep health should be treated as part of cardiometabolic risk assessment, not as a secondary lifestyle detail.
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