Addressing sleep disturbances: An opportunity to prevent cardiometabolic disease?

Abstract

There is increasing awareness of the role of sleep disturbance as an important factor in health and disease. Although sub-clinical sleep disturbances (insufficient sleep duration or inadequate sleep quality) may be difficult to assess with conceptual and/or methodological clarity, this review attempts to summarize and synthesize these findings. First, the concept of sleep disturbance in a public health context is introduced, to provide context and rationale. Second, operational definitions of ‘cardiometabolic disease’ and ‘sleep disturbance’ are offered, to address many unclear operationalizations. Third, the extant literature is summarized regarding short or long sleep duration and/or insufficient sleep, insomnia and insomnia symptoms, general (non-specific sleep disturbances), circadian rhythm abnormalities that result in sleep disturbances, and, briefly, sleep-disordered breathing. Fourth, the review highlights the social/behavioural context of sleep, including discussions of sleep and race/ethnicity, socio-economic position, and other social/environmental factors, in order to place these findings in a social-environmental context relevant to public health. Fifth, the review highlights the issue of sleep as a domain of health behaviour and addresses issues regarding development of healthy sleep interventions. Finally, a research agenda of future directions is proposed.

Acknowledgements

I wish to thank Michael Perlis for insight and comments regarding the ideas presented in this review. The social-ecological model was originally developed with the assistance of Nirav Patel, Lauren Hale, and Melisa Moore, and was refined with the assistance of Orfeu Buxton and Girardin Jean-Louis.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

This work was supported by the National Heart, Lung and Blood Institute (K23HL110216), the National Institute of Environmental Health Science (R21ES022931), and the Clinical and Translational Science award of the University of Pennsylvania (UL1RR024134).