Correlation analysis between sleep quality and carotid atherosclerosis in low and moderate risk individuals for cardiovascular and cerebrovascular diseases

Abstract

Objective·To explore the relationship between sleep quality and carotid atherosclerosis in the population with low or moderate risk of cardiovascular and cerebrovascular diseases.Methods·Based on the population-based cohort study of chronic diseases in Xinjiang, the researchers selected residents aged 35－75 from two fixed communities in Urumqi and Korla, in Northern and Southern Xinjiang, respectively, using a two-stage random cluster sampling method from July 2019 to September 2021. In the population without a history of coronary heart disease and cerebrovascular events, the prediction model for atherosclerotic cardiovascular disease (ASCVD) risk in China (China-PAR) was used to evaluate the risk of cardiovascular and cerebrovascular diseases. Low and moderate risk population of cardiovascular and cerebrovascular diseases were included. Participants completed physical examinations, questionnaires [including the Risk Factors Assessment Scale of Cardiovascular and Cerebrovascular Diseases in Xinjiang, Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and Food Frequency Questionnaire], cardiovascular and metabolic biochemical examinations, and carotid color doppler. Carotid intima-media thickness (CIMT) and plaque formation were used to determine the carotid atherosclerosis of the study subjects. Multivariate Logistic regression model and restricted cubic spline (RCS) were used to analyze the relationship between sleep quality and carotid intima-media thickening/plaque formation in the population with low and moderate risk of cardiovascular and cerebrovascular diseases.Results·A total of 1 528 subjects were included in the study, the mean age was (49.4±8.2) years, and 685 (44.8%) were male. In the included population, there were 581 (38.0%) subjects with carotid intima-media thickening and 305 (20.0%) subjects with carotid plaque formation. Among them, intima-media thickening and plaque formation both occurred in 154 (10.1%) people. Therefore, the prevalence of carotid atherosclerosis was 47.9% (732 subjects). Compared with the group without carotid artery thickening, the group with carotid intima-media thickening/plaque formation had higher levels of general cardiovascular and cerebrovascular risk factors, including age, male ratio, blood lipid levels and obesity, and higher PSQI sleep score [(7.06±2.13) vs (7.43±2.51), P=0.001]. The proportion of patients with poor sleep quality was higher (6.5% vs 12.1%, P=0.001). Multivariate Logistic regression analysis showed that poor sleep quality was an independent risk factor for carotid atherosclerosis [adjusted OR (aOR)=1.22, 95%CI 1.004－1.492, P=0.040]. RCS analysis suggested that PSQI and the risk of carotid atherosclerosis showed a positive linear correlation, that is, the worse quality of sleep, the higher risk of carotid atherosclerosis.Conclusion·Although the traditional metabolic risk factors are at a low risk level, the prevalence of carotid atherosclerosis is high and poor sleep quality is an independent risk factor for carotid atherosclerosis in the low and moderate risk population of cardiovascular and cerebrovascular diseases.

Keywords

• cardiovascular and cerebrovascular disease
• sleep quality
• risk stratification
• atherosclerosis