Sleep and Cardiovascular Health

Several recent publications and presentations of data on the relationship between sleep patterns and vascular disease occurred at the recent meeting of the European Society of Cardiology. The PESA (Progression of Early Subclinical Atherosclerosis) study performed by Dr Fernando Dominguez, MD, of the Spanish National Center for Cardiovascular Research in Madrid talked about the dangers of too little or too much sleep.

The principal researcher, Valentin Fuster, MD PhD, looked at 3,974 middle-aged bank employees known to be free of heart disease and stroke. They wore a monitor to measure sleep and activity. Interestingly, while only about 11% reported sleeping six or fewer hours per night, the monitor showed the true figure was closer to 27%. They found those who slept less than six hours per night had more plaque in their arteries than those people who slept six to eight hours. They additionally looked at people who slept an average of greater than eight hours.

Sleeping longer had little effect on men’s progression of atherosclerosis but had a marked effect of increasing atherosclerosis in women. Researchers then adjusted the data for family history, smoking, hypertension, hyperlipidemia, diabetes and other known cardiovascular risk factors. They found that there was an 11% increase in the risk of diagnosis of fatal or non-fatal cardiovascular disease in people who slept less than six hours per night compared to people who slept 6-8 hours per night. For people who slept an average of greater than eight hours per night they bore a 32% increased risk as compared to persons who slept 6-8 hours on average. Their conclusion was distilled down into this belief: “Sleep well, not too long, nor too short and be active.”

In a related study, Moa Bengtsson, an MD PhD student at the University of Gothenburg in Sweden presented data on 798 men who were 50 years old in 1993 when they were given a physical exam and a lifestyle questionnaire including sleep habits. Twenty one years later 759 of those men were still alive and they were examined and questioned. Those reporting sleeping five hours or less per night were 93% more likely to have suffered an MI by age 71 or had a stroke, cardiac surgery, and admission to a hospital for heart failure or died than those who averaged 7-8 hours per night.

While neither study proved a direct cause and effect between length of sleep and development of vascular disease, there was enough evidence to begin to believe that altering sleep habits may be a way to reduce future cardiovascular disease.

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Low Dose Zolpidem (Ambien) for Middle of the Night Awakening

Staying asleep and getting back to sleep after awakening are major issues for seniors.   In the past, physicians were counseled not to use drugs like Zolpidem (Ambien) unless a user had a good 7- 8 hours after taking the drug to remain in bed and rest while the product is metabolized and leaves their body.  The drug is relatively long acting and has been associated with sleep walking, day time sleepiness, falling and motor vehicle accidents especially when the user takes them in the middle of the night and awakens early for activities. Seniors are particularly prone to night time awakening for toileting activities, aches and pains and other issues.

The FDA has just approved a low dose version of Zolpidem for those patients who awaken in the middle of the night and cannot get back to sleep.  It is manufactured under the brand name Intermezzo in doses of 1.75 mg for women and 3.5 mg for men. The difference in dosing is based on the difference in the speed at which men and women metabolize the drug.

I am advising my patients to please be patient and allow us to evaluate how this product performs in large numbers of human subjects. The original studies were performed on 375 patients. It will be interesting to see if this product will be appropriate for overnight airplane travelers on four and five hour plane flights as well.