The role of sleep in cardiovascular health and disease risk

Sleep is a multidimensional physiological state, and it is increasingly recognized as a core determinant of cardiovascular (CV) health. This review summarises the CV health attributes of important sleep dimensions, including sleep duration, regularity, timing, quality, efficiency, and napping. New device-measured data continue to demonstrate the importance of both direct and synergistic effects of sleep with movement and dietary lifestyle behaviours in relation to CV risk. Emerging adoption of the 24-hour framework by guidelines highlights the importance of addressing sleep, as part of the broader cluster of lifestyle-related health behaviours, for a more comprehensive understanding of health risks and intervention opportunities. The reviewed literature indicates that sleep, both independently and through its interrelationships with other lifestyle behaviours, plays an important role in shaping CV health. We identified potential interconnected mechanisms through which poor sleep may influence risk of cardiovascular disease (CVD), including heightened sympathetic drive, altered neuroendocrine activity, inflammatory and immune changes, metabolic dysregulation, and weight gain. Large-scale device-based prospective studies capturing multidimensional sleep characteristics are needed to further delineate causal pathways linking sleep dimensions to CV risk. Such an evidence base will advance holistic CVD prevention through better clinical interventions and public health policy.