Elsevier

Sleep Medicine

Volume 16, Issue 12, December 2015, Pages 1482-1488
Sleep Medicine

Original Article
Relationship between short sleep duration and cardiovascular risk factors in a multi-ethnic cohort – the helius study

https://doi.org/10.1016/j.sleep.2015.08.014Get rights and content

Highlights

  • The association was partly consistent for obesity and diabetes across ethnic groups.

  • The association was not consistent for hypertension and lipids across ethnic groups.

  • Social economic status (SES) and lifestyle factors contributed little to the observed associations.

Abstract

Background and Aim

The aim of this study was to investigate the association between short sleep duration and cardiovascular disease (CVD) risk factors including hypertension, diabetes, obesity and lipid profile among various ethnic groups (South Asian Surinamese, African Surinamese, Ghanaians, Turks, Moroccans and the Dutch) living in the Netherlands. The contribution of social economic status (SES) and lifestyle factors were also examined to this association.

Method

A total of 12,805 participants (aged 18–70 years) from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) cohort. Short sleep duration was defined as <7 h/night. The association between short sleep and CVD risk factors, along with the contribution of SES and lifestyle factors, was assessed using prevalence ratios (PRs).

Results

Short sleep was significantly associated with obesity in four out of six ethnic groups, with the socio-demographic-adjusted PR of 1.45 (95% CI, 1.07–1.95) in the Dutch, 1.21 (1.01–1.44) in South Asian Surinamese, 1.25 (1.09–1.43) in African Surinamese and 1.16 (1.04–1.29) in Turks. Short sleep was significantly associated with diabetes in African Surinamese (1.45, 1.14–1.84), Turks (1.59, 1.26–2.02) and Moroccans (1.29, 1.02–1.63). By contrast, the associations between other cardiovascular risk factors and short sleep were not significant in most ethnic groups, with the exception of the association with hypertension in the Dutch and Turks, and dyslipidaemia in South Asian Surinamese (reduced high-density lipoprotein cholesterol and triglyceride) and Moroccans (raised total cholesterol). SES and lifestyle factors contributed little to the observed associations.

Conclusion

The findings indicate that short sleep is associated with obesity and diabetes in most ethnic groups. The associations for other risk factors vary between ethnic groups. Further studies are warranted to establish the potential factors that might lead to the observed differences across populations.

Introduction

Cardiovascular disease (CVD) is the leading cause of global mortality. Several prospective and retrospective studies have shown that hypertension, diabetes, obesity and dyslipidaemia are important risk factors for CVD [1], [2]. As the prevalence of these risk factors (especially obesity and diabetes) is increasing in adult populations in most countries [3], the necessity to identify potential modifiable risk factors increases, in order to reduce adverse CVD outcomes.

Recently, several studies have shown conflicting reports on the association between sleep duration and cardiovascular risk factors including hypertension [4], [5], diabetes [6], [7], [8], [9], obesity [10], [11], [12] and dyslipidaemia [13], [14], [15], [16], [17], [18], [19]. The fact that two independent studies showed an association between short sleep and cardiovascular mortality is supportive of the hypothesis that short sleep is related to CVD risk factors [20], [21]. Recent studies indicated that the relationship between sleep duration and CVD risk factors varies between study populations [22], [23]. This suggests that the potential importance of contextual factors, such as sociocultural and lifestyle factors, may influence the association. Previous studies suggested that the association between sleep duration and CVD risk may be mediated by SES, lifestyle factors and other covariates; they were therefore recommended to be included in future studies [24].

Studies investigating the relationship between sleep duration and cardiovascular risk factors have not considered differences among ethnic minority groups with different migration backgrounds. In addition, CVD and risk factors also differ between ethnic groups [25], [26], [27], [28], [29]. For instance, Surinamese people in the Netherlands have higher incidence rates of stroke in comparison to the European Dutch. By contrast, Moroccans have lower incidence rates of stroke compared with the Dutch [30]. In addition, ethnic minority groups tend to experience shorter sleep duration in comparison to their host European majority populations [29]. Given the variation in the association between short sleep and CVD risk factors between populations, it is important to elucidate how short sleep is related to CVD risk factor in different ethnic groups. Furthermore, the data on the relationship between short sleep and CVD risk factors across ethnic minority groups are lacking particularly in Europe. Using data from the Healthy Life in an Urban Setting (HELIUS) study, the aim of this study was to investigate whether there are differences in the association of sleep duration with cardiovascular risk factors between various ethnic minority groups living in the Netherlands. In addition, the contribution of SES and lifestyle factors to these associations was examined.

Section snippets

Study population

This study was based on baseline data from the HELIUS study. The aims and design of the HELIUS study have been described elsewhere [30]. In brief, HELIUS is a large-scale prospective cohort study on health and healthcare among different ethnic groups living in Amsterdam. The study started in 2011 and includes individuals aged between 18 and 70 years from the six major ethnic groups in Amsterdam (African-Surinamese, South Asian Surinamese, Turks, Moroccan, Ghanaian and Dutch origin). This study

Characteristics of the study population

Table 1 shows the characteristics of the study population by ethnic group. Moroccans and Turks were younger, had lower educational levels, consumed less alcohol, less often achieved the physical activity norm and had lower prevalence of hypertension in comparison to Dutch and other ethnic origin groups. South Asian Surinamese, African Surinamese, and Ghanaian participants had a lower mean sleep duration and a higher prevalence of short sleep than the Dutch, Turks, and Moroccans. The Dutch and

Key finding

This study investigated whether there are differences in the association between short sleep duration and CVD risk factors across various ethnic minority groups living in the Netherlands. The result of this study reported that sleep duration was associated with CVD risk factors, but the association varies between ethnic groups and depends on the CVD risk factor being considered. Short sleep was significantly associated with obesity and diabetes in most ethnic groups. By contrast, the

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.08.014.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

Acknowledgements

The Healthy Life in an Urban Setting (HELIUS) study is conducted by the Academic Medical Centre (AMC), Amsterdam and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (2010T084), the Netherlands Organisation for Health Research and Development (ZonMW): 200500003 and the European Union Seventh Framework Programme (FP-7): 278901. We gratefully acknowledge the AMC Biobank for their support in

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