A comprehensive scientific statement released by the American Heart Association (AHA) concludes that healthy sleep is far more than just hours spent asleep each night. It also includes other components such as how long it takes to fall asleep, daytime functioning, and self-reported sleep satisfaction. Addressing the multiple dimensions of sleep health has the potential to significantly impact cardiometabolic health (CMH) and related risk factors, according to the AHA statement published in Circulation: Cardiovascular Quality and Outcomes.
“Most adults need seven to nine hours of sleep each night, and suboptimal sleep raises the risk for cardiovascular disease, along with risk of cognitive decline, depression, obesity, as well as high blood pressure, blood sugar, and cholesterol levels,” said Marie-Pierre St-Onge, PhD, an associate professor of nutritional medicine at Columbia University Irving Medical Center who chaired the writing group. “However, there is increasing evidence that sleep health is about more than the number of hours you sleep each night.”
This broader definition, referred to as multidimensional sleep health, may mark a shift in how clinicians approach patient sleep in the context of heart disease, stroke, obesity, type 2 diabetes, and other CMH-related conditions.
To reach their conclusion, the writing group synthesized data from studies using both subjective and objective sleep measures, including actigraphy and polysomnography. Findings showed that sleeping less than seven hours or more than nine hours per night is associated with higher risks of atrial fibrillation, cardiometabolic syndrome, stroke, and cardiovascular mortality. In addition, fragmented sleep, poor timing (such as going to bed after midnight), and irregular patterns (such as weekday-weekend differences) are each independently associated with worse CMH outcomes.
“Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality,” the group wrote.
Importantly, sleep disparities were highlighted as a key issue. Individuals from underrepresented racial and ethnic groups, particularly Black adults, consistently report shorter, more irregular, and lower-quality sleep. The report points to adverse social drivers of health such as environmental noise, safety, and socioeconomic status as contributing factors.
“It’s important to know that every individual has different sleep experiences, and these differences may contribute to other health inequities,” said St-Onge.
The report also examined the impact of sleep-related daytime functioning—how poor sleep quality or quantity impacts a person’s sleepiness during waking hours. Excessive daytime sleepiness, the report said, has been linked to cardiovascular disease, coronary heart disease, and stroke. Other sleep metrics such as satisfaction and architecture (the ratio of different sleep stages) were shown to impact insulin resistance and cardiovascular risk.
Despite these associations, the statement acknowledges that “guidance on multidimensional sleep health cannot be made without evidence that improving sleep health leads to better CMH.” Most interventions to date have focused narrowly on extending sleep duration, but writers point out there is a need for broader clinical trials and population studies that evaluate sleep across dimensions and how they interact.
Additional studies should take a multidisciplinary research approach across a number of medical specialties including sleep medicine, cardiology, endocrinology, and neurology. “We therefore call for population studies to evaluate associations of multidimensional sleep health, using tools and definitions provided herein, with CMH,” the reports stated. Future studies should also assess the value of simple clinical tools like RU_SATED, a sleep health questionnaire, to guide individualized care.
Clinically, the authors suggest their findings could be used immediately by integrating sleep health questions into routine care: asking patients about how long it takes to fall asleep, how often they wake during the night, and how alert they feel during the day. This information, they wrote, “should be included in the patient’s chart so that all health care professionals involved in the patient’s care are aware of their sleep health. Clinicians are encouraged to discuss sleep using the multidimensional sleep health framework presented herein with their patients.”
