Sleep is a physiological process that every human needs. It allows the body to sleep, repair, and even rejuvenate, and has profound implications for the health of the body’s systems, especially the cardiovascular system, as emphasized in an article published in the Cardiology journal from the American College of Cardiology.

However, sleep patterns are often not considered in a patient’s clinical or cardiologic workup as a factor to be taken into account when assessing cardiac health.

Along with a healthy diet and regular physical activity, sleep is a crucial pillar of wellness. Besides regulating circadian rhythm, it fulfills many physiological functions that are essential for maintaining vascular integrity and heart function.

This is true for both optimal and poor sleep patterns, as both have major effects on cardiovascular health.

For some time, heart specialists have been attempting to integrate sleep analysis more effectively into routine clinical practice. In fact, the American Heart Association (AHA) said just that in its 2016 Scientific Statement.

Another important step was the inclusion of sleep in the list of “Life’s Essential 8”in 2022, which emphasized its role in maintaining healthy blood pressure, cholesterol, and body weight, all key factors in heart health.

Sleep apnea, one of the most common conditions related to poor sleep, appears to have a critical effect on the cardiovascular system.

People with obstructive sleep apnea (OSA) often snore loudly, their breathing pauses and stops during the night, and they may wake up several times. This not only causes tiredness but can also increase the risk of high blood pressure, stroke, and heart diseases, according to an August press release from the European Society of Cardiology that analyzed the advantages and disadvantages of treatment for this condition.

Longitudinal studies have established a strong association between OSA severity and adverse outcomes, [EE1] such as left ventricular hypertrophy, arrhythmia, and ischemic events. Its prevalence ranges from 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, and atrial fibrillation. OSA is strongly associated with a higher risk of stroke and heart failure.

One of the risks of poor sleep (whether it’s too much or too little) or of not being able to fall or stay asleep is that it may become a chronic condition.

Chronic sleep deprivation alters homeostatic processes, which causes increased activity in the sympathetic nervous system, hyperactivation of the hypothalamic‑pituitary‑adrenal axis, and systemic inflammation.

These alterations have multiple side effects, such as raising baseline blood pressure and contributing to arterial stiffening, which increases the risk of hypertension and cardiovascular morbidity.

Just like sleep duration, sleep quality is also related to cardiovascular outcomes. A meta‑analysis of seven prospective studies with sample sizes between 2960 and 487,200 participants and a median follow‑up of 10.6 years examined the association between insomnia symptoms and cardiovascular diseases. The risk of cardiovascular disease was about 16% higher in individuals who did not have restful sleep, among other concerning percentages.

A more recent study demonstrated that both difficulty falling asleep as well as trouble staying asleep more than twice a week were related to worse cardiovascular outcomes.

Experts from the American College of Cardiology have the following recommendations for health providers:

Screen for sleep disorders. Routinely evaluate patients for sleep disorders, especially obstructive sleep apnea, which significantly increases cardiovascular risk.

Promote sleep hygiene. Educate patients about good sleep practices, including maintaining a consistent sleep schedule and creating a sleep‑promoting environment.

Integrate sleep metrics. Incorporate sleep duration and quality assessments into cardiovascular risk profiles and management plans.

Monitor comorbidities. Pay close attention to resistant conditions (hypertension, diabetes) and consider that they may be caused or exacerbated by poor sleep.

Collaborate with specialists. Refer patients with suspected sleep disorders to sleep medicine specialists for diagnosis and treatment.