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Original research article
Cardiovascular health and sleep disturbances in two population-based cohort studies
  1. Nadine Hausler1,
  2. Quentin Lisan2,3,4,
  3. Thomas Van Sloten2,3,5,
  4. Jose Haba-Rubio6,
  5. Marie-Cécile Perier2,3,
  6. Frédérique Thomas7,
  7. Nicolas Danchin2,7,8,
  8. Catherine Guibout2,3,
  9. Pierre Boutouyrie2,9,10,
  10. Raphael Heinzer6,
  11. Xavier Jouven2,3,8,
  12. Pedro Marques-Vidal1,
  13. Jean-Philippe Empana2,3
  1. 1 Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
  2. 2 Universite Paris Descartes, Paris, France
  3. 3 Paris Cardiovascular Research Center, Department of Epidemiology, INSERM, UMR-S970, Paris, France
  4. 4 Department of Head and Neck surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
  5. 5 Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  6. 6 Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland
  7. 7 Preventive and Clinical Investigation Center, Paris, France
  8. 8 Department of Cardiology, Georges PompidouEuropean Hospital, AP-HP, Paris, France
  9. 9 Department of Pharmacology, Georges PompidouEuropean Hospital, AP-HP, Paris, France
  10. 10 Paris Cardiovascular Research Center, Department of Arterial Mechanics, INSERM, UMR-S970, Paris, France
  1. Correspondence to Dr Quentin Lisan, Universite Paris Descartes, Paris 75270, France; quentin.lisan{at}


Objective We aimed to investigate the association between cardiovascular health (CVH), as defined by the American Heart Association, and several sleep disturbances.

Methods Two community-based cohorts, the Paris Prospective Study 3 (PPS3, France, n=6441) and the CoLaus study (Switzerland, n=2989) were analysed. CVH includes 7 metrics which all can be classified as poor, intermediate and ideal. Global CVH score was categorised into poor (0–2 ideal metrics), intermediate (3–4 ideal metrics) and ideal (≥5 ideal metrics). Associations between global CVH and self-reported sleep disturbances (proxy of sleep-disordered breathing [SDB], excessive daytime sleepiness, insomnia symptoms and short/long sleep duration) and SDB severity measured by polysomnography (PSG) were investigated. Adjusted OR/relative risk ratio (RRR) and 95% CIs were estimated. Subjects with previous cardiovascular disease were excluded.

Results Compared with poor CVH, subjects with intermediate and ideal global CVH had lower odds of self-reported SDB in both cohorts (ORs 0.55; 95% CI 0.44 to 0.68 and 0.35; 95% CI 0.22 to 0.53, respectively) and had lower SDB severity measured by PSG (RRR 0.07; 95% CI 0.02 to 0.20) in CoLaus. Subjects with intermediate and ideal global CVH had lower odds of excessive daytime sleepiness in PPS3 (ORs 0.82; 0.72 to 0.95 and 0.80; 0.82 to 1.02, respectively). No consistent associations were found between CVH and sleep duration or insomnia symptoms.

Conclusions Higher levels of CVH are associated with lower odds of SDB and excessive daytime sleepiness. However, causal interpretation cannot be made and associations might be bidirectional.

  • cardiac risk factors and prevention
  • epidemiology

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  • PM-V and J-PE contributed equally.

  • NH and QL contributed equally.

  • Contributors Acquisition, analysis or interpretation of data: QL, NH, PM-V and J-PE. Drafting of the manuscript: QL and NH. Critical revision of the manuscript for important intellectual content: All authors.Statistical analysis: QL and NH. Obtained funding: XJ, J-PE, PB, JH-R, PM-V and RH. Administrative, technical or material support: JH-R, FT, ND, PB, PM-V, XJ and J-PE.

  • Funding The PPS3 Study was supported by grants from The National Research Agency (ANR), the Research Foundation for Hypertension (RFHTA), the Research Institute in Public Health (IRESP) and the Region Ile de France (Domaine d’Intérêt Majeur). The CoLaus study was and is supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne and the Swiss National Science Foundation (grants 33CSCO-122661, 33CS30-139468, 33CS30-148401 and grant 320030E-176280).

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Ethics Committee of the Cochin Hospital (Paris, France) and Institutional Ethics Committee of the University of Lausanne (references 16/03 and 33/09).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.