A new Scientific Statement from the American Heart Association highlighted that sleep factors beyond how many hours an individual sleeps per night could affect heart and metabolic health.
The report defined multidimensional sleep health as including not just sleep duration, but also continuity, timing, regularity, satisfaction, daytime alertness, sleep architecture, and the absence of sleep disorders.
“Sleep is not a unitary physiologic experience, and multiple sleep dimensions affect functioning in various ways,” the study authors wrote, calling on health care providers to adopt a broader approach in evaluating patients’ sleep health.
While sleep duration is already part of the American Heart Association's (AHA) Life’s Essential 8 cardiovascular health metrics, the investigators noted that this single measure may not capture the full impact of sleep on health. Evidence has shown that both short (less than 7 hours) and long (more than 9 hours) sleep could be linked to increased risks of obesity, stroke, type 2 diabetes, and cardiovascular disease (CVD).
For instance, sleeping 11 hours or more was associated with a 47% higher risk of all-cause mortality, and sleeping 5 hours or less raised stroke risk by 20%.
Poor sleep continuity, including frequent waking and trouble falling asleep, was tied to a higher risk of hypertension and coronary heart disease. One meta-analysis found that individuals with insomnia and short sleep had almost double the risk of high blood pressure.
Late bedtimes—after midnight—were linked to general and abdominal obesity. A delayed sleep midpoint was associated with higher fasting glucose and increased blood pressure.
Irregular sleep patterns such as differing bedtimes and wake times during the week were also found to increase the risk of cardiovascular issues. In one study, participants with the most irregular sleep had nearly double the risk of CVD-related mortality compared with those with regular sleep.
Daytime sleepiness, a sign of poor nighttime sleep, was associated with stroke, CVD, and all-cause mortality. One meta-analysis showed a 52% higher risk of stroke among individuals with excessive daytime sleepiness.
The AHA also highlighted that sleep health disparities exist, especially among Black individuals and those with lower socioeconomic status. These groups may be more likely to have short or irregular sleep and report lower satisfaction with their sleep—factors that may increase their risk for chronic disease.
The investigators recommended that clinicians use open-ended questions like “How is your sleep?” to learn about more than just sleep duration. They encourage incorporating multiple sleep metrics into patient evaluations.
While more research is needed to determine which sleep measures should be prioritized, the AHA urged clinicians to consider sleep health more comprehensively to better address cardiovascular risk.
“We urge the medical and scientific communities to consider evaluating multiple facets of sleep health,” the study authors concluded.
No conflicts of interest were declared in the study.