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Cited by 166Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

Sleep: important considerations for the prevention of cardiovascular disease

Open access
Grandner, Michael A., Alfonso-Miller, Pamela, Fernandez-Mendoza, Julio, Shetty, Safal, Shenoy, Sundeep, Combs, Daniel·2016·Current Opinion in Cardiology
DOI 10.1097/hco.0000000000000324PMC PMC5056590
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Abstract

PURPOSE OF REVIEW: Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. RECENT FINDINGS: Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. SUMMARY: Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.

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Written from the paper’s full text.

TL;DR

This narrative review argues that insufficient sleep duration, sleep apnea, and insomnia are important, potentially modifiable risk factors for cardiometabolic disease and cardiovascular mortality. It summarizes epidemiologic, clinical, and laboratory evidence and recommends routine screening and treatment, especially for sleep apnea and insomnia with short sleep duration.

Key findings

  • Habitual short sleep is common and linked to cardiometabolic risk: NHANES 2005–2008 reported <7 h sleep in 37.0% of adults aged 20–39 and 40.3% of those aged 40–59, versus 32% of those over 60; CDC data show >30% of US adults report <7 h. Sleep duration and mortality are U-shaped, with lowest risk at 7–8 h; in 20,432 healthy Dutch adults over 12 years, ≤6 h sleep was associated with 15% higher CVD incidence and 23% higher CHD incidence, and short sleep plus poor subjective sleep with 63% higher CVD and 79% higher CHD risk.
  • Obstructive sleep apnea (OSA) is highly prevalent and associated with cardiovascular disease: AHI ≥5 prevalence was 22% in men and 17% in women across 11 studies, with more recent estimates of 37% in men and 50% in women; prevalence is about 50% in obesity and about 60% for moderate-severe OSA in metabolic syndrome. Severe OSA was linked to fatal cardiovascular events (OR 2.87) and non-fatal events (OR 3.17); hypertension odds were 2.89 for AHI >15, and CPAP improved blood pressure, glycemic control, and some cardiovascular outcomes.
  • Insomnia, especially with objective short sleep, predicts cardiometabolic risk: prevalence ranges from 8–40%; insomnia with PSG-measured sleep <6 h had T2D odds of 2.1–3.0 and hypertension odds of 3.5–5.1 cross-sectionally and 3.8 longitudinally, while insomnia with >6 h sleep was not significantly increased (OR 1.3 and 0.85). Meta-analytic risks included incident hypertension 5–20%, type-2 diabetes about 57%, and MI/CHD 41–55%.
  • Pediatric sleep-disordered breathing and sleep disparities are also implicated: OSA occurs in 1.2–5.7% of children, and 55% of children with hypertension referred for polysomnography had sleep-disordered breathing. Blacks/African-Americans were 3.5 times as likely to report <5 h sleep and twice as likely to report 5–6 h sleep versus non-Hispanic Whites; non-Mexican Hispanics/Latinos were 87% more likely to report very short sleep and 35% more likely short sleep; Asians/Others were 2.5 times as likely to report very short sleep and 67% more likely short sleep.

Methods

  • Design: narrative review summarizing literature across sleep duration, sleep disorders, pediatric populations, and cardiovascular health disparities; no primary data collection.
  • Data/sample: cites laboratory, clinical, and epidemiologic studies, including NHANES, BRFSS, prospective cohorts (e.g., MORGEN, Penn State Adult Cohort), meta-analyses, and randomized trials.
  • Analysis: qualitative synthesis of associations and mechanisms; no systematic search or pooled quantitative analysis is reported.

Limitations

  • Stated: mechanisms linking sleep to morbidity are not completely delineated; future studies are needed to better characterize mechanisms and identify/refine interventions.
  • Stated for cited evidence: many studies are cross-sectional, lack polysomnography, cannot control for sleep-disordered breathing, or have limited follow-up; for example, insomnia–CVD studies were often modest and lacked PSG/SDB control, and OSA–dyslipidemia causality remains unclear.
  • Evident: as a narrative review, it does not report a systematic search strategy, risk-of-bias assessment, or meta-analysis, so conclusions reflect the authors’ selected synthesis.

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Integrity signals

Registry

Crossref · 10.1097/hco.0000000000000324

Cites

253 of 253 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

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  • Premisecitation

    A recent meta-analysis did not find a consistent association between short sleep and inflammation.

    “A recent meta-analysis did not find a consistent association between short sleep and inflammation(57).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Premisecitation

    Insufficient sleep duration is associated with weight gain and obesity.

    “short sleep duration (6 hours or less), and especially very short sleep duration (less than 5 hours) is associated with increased cardiometabolic morbidity and mortality, including weight gain and obesity, hypertension, hyperlipidemia, and diabetes.”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [24] Morselli LL Guyon A Spiegel K Sleep and metabolic function. Pflugers Arch 2012 463 1 139 60 22101912 PMC3289068 source

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    • cites [25] Knutson KL Spiegel K Penev P Van Cauter E The metabolic consequences of sleep deprivation. Sleep Med Rev 2007 11 3 163 78 17442599 PMC1991337 source

      Not checked in the free run.

    • cites [27] Tasali E Leproult R Spiegel K Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis 2009 51 5 381 91 19249444 source

      Not checked in the free run.

    • cites [28] Van Cauter E Spiegel K Tasali E Leproult R Metabolic consequences of sleep and sleep loss. Sleep Med 2008 9 Suppl 1 S23 8 18929315 PMC4444051 source

      Not checked in the free run.

    • cites [29] Spiegel K Knutson K Leproult R Tasali E Van Cauter E Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol 2005 99 5 2008 19 16227462 source

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    • cites [30] Spiegel K Leproult R L'Hermite-Baleriaux M Copinschi G Penev PD Van Cauter E Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 2004 89 11 5762 71 15531540 source

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    • cites [31] Spiegel K Leproult R Van Cauter E Impact of sleep debt on metabolic and endocrine function. Lancet 1999 354 9188 1435 9 10543671 source

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  • Premisecitation

    Sleep deprivation is associated with increased inflammation.

    “Sleep deprivation has been associated with increased inflammation and negative cardiovascular outcomes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Premisecitation

    Habitual short sleep duration is highly prevalent in the US population.

    “Taken together, habitual short sleep duration is highly prevalent in the US population.”
    • Also stated in: § Current Findings · plain
      “Insufficient sleep duration is prevalent in the population”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • Premisecitation

    In men aged 40-70 years with severe OSA (AHI >30), there is increased all-cause mortality, specifically from coronary artery disease.

    “showed increased all-cause mortality, specifically from coronary artery disease, in men aged 40-70 years with severe OSA characterized by apnea-hypopnea index (AHI) of greater than 30(83).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Punjabi NM Caffo BS Goodwin JL Gottlieb DJ Newman AB O'Connor GT Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009 6 8 e1000132 19688045 PMC2722083 source

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  • May combine two claims. 52
  • Classified as probably not a substantial claim. 6

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    Premisecitation

    Severe OSA is linked to an increased risk of fatal cardiovascular events (OR 2.87; 1.17-7.51) and non-fatal cardiovascular events (OR 3.17, 1.12-7.51) compared to healthy controls.

    “severe OSA was linked to an increased risk of fatal cardiovascular events (odds ratio of 2.87; 1.17 – 7.51) as well as non-fatal cardiovascular events (odds ratio of 3.17, 1.12 −7.51) compared to a control of healthy individuals(84).”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    Sleep duration and mortality are associated in a U-shaped fashion, with lowest risk at 7-8 hours and increased risk with deviation.

    “Sleep duration and mortality are associated in a U-shaped fashion, where lowest risk is usually found in those who sleep between 7-8 hours, and mortality risk increasing with further deviation on either end of the range.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Grandner MA Patel NP Hale L Moore M Mortality associated with sleep duration: The evidence, the possible mechanisms, and the future. Sleep Med Rev 2010 14 191 203 19932976 PMC2856739 source

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    Premisecitation

    The prevalence of OSA in obesity is about 50%, with much higher prevalence in morbidly obese individuals.

    “The prevalence of OSA in obesity is about 50% (76), with much higher prevalence in morbidly obese individuals.(77)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [76] Resta O Foschino-Barbaro MP Legari G Talamo S Bonfitto P Palumbo A Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord 2001 25 5 669 75 11360149 source

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    Premisecitation

    Insufficient sleep is linked to lower energy expenditure, altered glucose homeostasis, and alterations in hormones that mediate hunger.

    “insufficient sleep has been linked to lower energy expenditure, altered glucose homeostasis and alterations in hormones that mediate hunger(24, 25, 27-31).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [24] Morselli LL Guyon A Spiegel K Sleep and metabolic function. Pflugers Arch 2012 463 1 139 60 22101912 PMC3289068 source

      Not checked in the free run.

    • cites [25] Knutson KL Spiegel K Penev P Van Cauter E The metabolic consequences of sleep deprivation. Sleep Med Rev 2007 11 3 163 78 17442599 PMC1991337 source

      Not checked in the free run.

    • cites [27] Tasali E Leproult R Spiegel K Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis 2009 51 5 381 91 19249444 source

      Not checked in the free run.

    • cites [28] Van Cauter E Spiegel K Tasali E Leproult R Metabolic consequences of sleep and sleep loss. Sleep Med 2008 9 Suppl 1 S23 8 18929315 PMC4444051 source

      Not checked in the free run.

    • cites [29] Spiegel K Knutson K Leproult R Tasali E Van Cauter E Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol 2005 99 5 2008 19 16227462 source

      Not checked in the free run.

    • cites [30] Spiegel K Leproult R L'Hermite-Baleriaux M Copinschi G Penev PD Van Cauter E Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 2004 89 11 5762 71 15531540 source

      Not checked in the free run.

    • cites [31] Spiegel K Leproult R Van Cauter E Impact of sleep debt on metabolic and endocrine function. Lancet 1999 354 9188 1435 9 10543671 source

      Not checked in the free run.

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    Premisecitation

    Chronic sleep insufficiency has played a role in motor vehicle accidents, industrial disasters, and medical and other occupational errors.

    “Chronic sleep insufficiency has played a role in motor vehicle accidents, industrial disasters, medical and other occupational errors, for instance(41, 42, 47-51).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
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    Premisecitation

    Short sleep duration is associated with elevated prevalence of hypertension, hyperlipidemia, and history of heart attack and stroke.

    “short sleep duration was associated with elevated prevalence of hypertension, hyperlipidemia and history of heart attack and stroke(16).”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    Short sleep duration (≤6 hours) is associated with a 15% higher risk of CVD incidence and a 23% higher risk of CHD incidence compared to 7-8 hours.

    “those individuals who slept ≤6 hours had a 15% higher risk of CVD incidence and a 23% higher risk of CHD incidence compared to people who slept 7-8 hours.”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    Epidemiological data supports that OSA can initiate cardiovascular conditions such as hypertension and ischemic heart disease and worsen existing disease.

    “Epidemiological data supports the idea that OSA can initiate not only cardiovascular conditions such as hypertension and ischemic heart disease but also worsen existing disease(80).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] Bradley TD Floras JS Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009 373 9657 82 93 19101028 source

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    Interpretationreasoning

    Short sleep duration (6 hours or less), and especially very short sleep duration (less than 5 hours), is associated with increased cardiometabolic morbidity and mortality, including weight gain and obesity, hypertension, hyperlipidemia, and diabetes.

    “Regarding cardiometabolic risk, short sleep duration (6 hours or less), and especially very short sleep duration (less than 5 hours) is associated with increased cardiometabolic morbidity and mortality, including weight gain and obesity, hypertension, hyperlipidemia, and diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    More recent studies indicate the prevalence of OSA is increasing, with an estimated prevalence of 37% in men and 50% in women.

    “More recent studies indicate that this is increasing, with an estimated prevalence of 37% in men and 50% in women(74, 75).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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    Premisecitation

    Sleep deprivation alters glucose homeostasis, leading to insulin resistance and risk of diabetes.

    “Sleep deprivation alters glucose homeostasis, leading to insulin resistance and risk of diabetes(17, 18, 24, 59-61).”
    Quote in the paperSubstantial claim0 of 6 sources checked
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    • cites [24] Morselli LL Guyon A Spiegel K Sleep and metabolic function. Pflugers Arch 2012 463 1 139 60 22101912 PMC3289068 source

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    • cites [59] Ioja S Weir ID Rennert NJ Relationship between sleep disorders and the risk for developing type 2 diabetes mellitus. Postgrad Med 2012 124 4 119 29 22913900 source

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    • cites [60] Lucassen EA Rother KI Cizza G Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci 2012 1264 1 110 34 22827862 PMC3418485 source

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    Premisecitation

    Sleep deprivation leads to cognitive impairment and reduced attention.

    “sleep deprivation leads to cognitive impairment and reduced attention(43-46).”
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    • cites [43] Goel N Basner M Rao H Dinges DF Circadian rhythms, sleep deprivation, and human performance. Progress in molecular biology and translational science 2013 119 155 90 23899598 PMC3963479 source

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    Premisecitation

    Improvement in glycemic control has been demonstrated after 3 months of CPAP use, with improvement related to number of hours of nightly CPAP use.

    “Improvement in glycemic control has been demonstrated after 3 months of CPAP use, with improvement related to number of hours of nightly CPAP use(107, 108).”
    Quote in the paperSubstantial claim0 of 2 sources checked
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    Premisecitation

    In patients with CAD and moderate OSA (AHI >15), CPAP use is associated with significantly decreased cardiovascular mortality, acute coronary syndrome, hospitalization from heart failure exacerbation, and need for coronary revascularization compared to non-use.

    “patients on CPAP had a significantly decreased cardiovascular mortality, acute coronary syndrome, hospitalization from heart failure exacerbation as well as need for coronary revascularization compared to the group which did not use the CPAP(93).”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    In patients with resistant hypertension, CPAP therapy produces a mean improvement of ambulatory SBP and DBP of −6.74 mm Hg (95% CI −9.98 to −3.49) and −5.94 mm Hg (95% CI −9.40 to −2.47), respectively.

    “showed the mean improvement of ambulatory SBP and DBP of −6.74 mm Hg (95% CI −9.98 to −3.49;P value <0.001) and −5.94 mm Hg (95% CI;-9.40 to −2.47;P=0.001) respectively(116).”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Premisecitation

    The prevalence of OSA in individuals with hypertension is estimated to be about 40-50% and approaches 83% in patients with resistant hypertension.

    “The prevalence of OSA in individuals with hypertension is estimated to be about 40-50%(112) and approaches 83% in patients with resistant hypertension(86).”
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    • cites [112] Silverberg DS Oksenberg A Are sleep-related breathing disorders important contributing factors to the production of essential hypertension? Curr Hypertens Rep 2001 3 3 209 15 11353571 source

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    • cites [86] Logan AG Perlikowski SM Mente A Tisler A Tkacova R Niroumand M High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001 19 12 2271 7 11725173 source

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    Premisecitation

    CPAP therapy in OSA patients produces a modest reduction in mean systolic blood pressure (−4.92 mm Hg; 95%CI −8.70 to −1.14) and mean nighttime blood pressure (−2.56 mm Hg; 95% CI −4.43 to −0.68 mmHg), but no significant change in daytime SBP or DBP.

    “Modest reduction in mean systolic blood pressure (SBP) (−4.92 mm Hg; 95%CI −8.70 to −1.14) and mean (−2.56 mm Hg; 95% CI −4.43 to −0.68 mmHg) nighttime blood pressure were seen. No significant change in daytime SBP (−0.74 mm Hg; 95% CI −3.9 to 2.41) and daytime diastolic blood pressure (−1.86 mm Hg; 95% CI −4.55 to 0.83) were observed, however.(115)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [115] Schein AS Kerkhoff AC Coronel CC Plentz RD Sbruzzi G Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients. J Hypertens 2014 32 9 1762 73 24979300 source

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    Premisecitation

    The prevalence of OSA among heart failure patients is about 30-50%, while that of central sleep apnea (CSA) is about 25-40%.

    “The prevalence of OSA among heart failure patients is about 30-50% while that of central sleep apnea (CSA) is about 25-40%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Zhai AB Yip A Haddad H Heart failure and sleep-disordered breathing. Curr Opin Cardiol 2016 31 2 224 8 26766163 source

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    Premisecitation

    The prevalence of insomnia in the general population ranges between 8-40%, depending on the definition used.

    “The prevalence of insomnia in the general population ranges between 8-40%, depending on the definition used.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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    Premisecitation

    In the Wisconsin sleep cohort study, the odds for the presence of hypertension were 2.03 for AHI 5.0-14.9 events per hour and 2.89 for AHI greater than 15 events per hour.

    “the odds for the presence of hypertension were 2.03 for apnea-hypopnea index (AHI) between 5.0 to 14.9 events per hour and 2.89 for AHI greater than 15 events per hour(113).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [113] Peppard PE Young T Palta M Skatrud J Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000 342 19 1378 84 10805822 source

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    Premisecitation

    Later studies found that 24-h urinary free cortisol, norepinephrine, and catecholamine metabolites levels were increased in patients with insomnia or were correlated with PSG indices of sleep disturbance in insomnia patients.

    “later studies found that 24-h urinary free cortisol, norepinephrine, and catecholamine metabolites levels were increased in patients with insomnia or were correlated with PSG indices of sleep disturbance in insomnia patients(148-151).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [148] Vgontzas AN Tsigos C Bixler EO Stratakis CA Zachman K Kales A Chronic insomnia and activity of the stress system: a preliminary study. J Psychosom Res 1998 45 1 Spec No 21 31 9720852 source

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    • cites [149] Vgontzas AN Bixler EO Lin HM Prolo P Mastorakos G Vela-Bueno A Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab 2001 86 8 3787 94 11502812 source

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    • cites [150] Rodenbeck A Cohrs S Jordan W Huether G Ruther E Hajak G The sleep-improving effects of doxepin are paralleled by a normalized plasma cortisol secretion in primary insomnia. A placebo-controlled, double-blind, randomized, cross-over study followed by an open treatment over 3 weeks. Psychopharmacology (Berl) 2003 170 4 423 8 13680082 source

      Not checked in the free run.

    • cites [151] Irwin M Clark C Kennedy B Christian Gillin J Ziegler M Nocturnal catecholamines and immune function in insomniacs, depressed patients, and control subjects. Brain Behav Immun 2003 17 5 365 72 12946658 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Insomnia is a disorder while 'poor sleep' is a symptom of underlying physical or mental health problems.

    “which indicates that insomnia is a disorder while “poor sleep” is a symptom of underlying physical or mental health problems(137, 138, 140).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [137] Singareddy R Vgontzas AN Fernandez-Mendoza J Liao D Calhoun S Shaffer ML Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med 2012 13 4 346 53 22425576 PMC3319648 source

      Not checked in the free run.

    • cites [138] Fernandez-Mendoza J Vgontzas AN Bixler EO Singareddy R Shaffer ML Calhoun SL Clinical and polysomnographic predictors of the natural history of poor sleep in the general population. Sleep 2012 35 5 689 97 22547895 PMC3321428 source

      Not checked in the free run.

    • cites [140] Vgontzas AN Fernandez-Mendoza J Bixler EO Singareddy R Shaffer ML Calhoun SL Persistent insomnia: the role of objective short sleep duration and mental health. Sleep 2012 35 1 61 8 22215919 PMC3242689 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a randomized, placebo-controlled trial, treatment of severe OSA with CPAP improved postprandial triglyceride levels as well as total cholesterol levels.

    “concluded that treatment of severe OSA with CPAP improved postprandial triglyceride levels as well as total cholesterol levels(129).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [129] Phillips CL Yee BJ Marshall NS Liu PY Sullivan DR Grunstein RR Continuous positive airway pressure reduces postprandial lipidemia in obstructive sleep apnea: a randomized, placebo-controlled crossover trial. Am J Respir Crit Care Med 2011 184 3 355 61 21527567 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with 'poor sleep' or insomnia are more likely to report increased alcohol and caffeine use, smoking, and lack of physical activity and to show lower cardiorespiratory fitness compared to normal sleepers.

    “individuals with “poor sleep” or insomnia are more likely to report increased alcohol and caffeine use, smoking, and lack of physical activity and to show lower cardiorespiratory fitness as compared to normal sleepers(142).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] Strand LB Laugsand LE Wisloff U Nes BM Vatten L Janszky I Insomnia symptoms and cardiorespiratory fitness in healthy individuals: the Nord-Trondelag Health Study (HUNT). Sleep 2013 36 1 99 108 23288976 PMC3524509 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with heart failure, CPAP in addition to standard heart failure therapy improves ejection fraction and quality of life.

    “patients treated with CPAP in addition to standard heart failure therapy had improved ejection fraction as well as improved quality of life(90).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [90] Mansfield DR Gollogly NC Kaye DM Richardson M Bergin P Naughton MT Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 2004 169 3 361 6 14597482 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with insomnia may be at increased CVD risk through poor diet, as subjective and objective sleep has been associated with dietary macronutrient and micronutrient composition.

    “individuals with insomnia may be at increased CVD risk through poor diet, as subjective and objective sleep has been associated with dietary macronutrient and micronutrient composition(143).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [143] Grandner MA Kripke DF Naidoo N Langer RD Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women. Sleep Med 2010 11 2 180 4 20005774 PMC2819566 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The majority of studies indicate that total cholesterol and LDL are unchanged, but triglyceride levels increase and HDL levels decrease in patients with OSA.

    “The majority of the studies indicate that the total cholesterol and LDL were unchanged. However, an increase in triglyceride levels and decrease in the HDL levels were noted in patients with OSA(120, 121).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [120] Roche F Xuong AN Court-Fortune I Costes F Pichot V Duverney D Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol 2003 26 3 669 77 12698666 source

      Not checked in the free run.

    • cites [121] Newman AB Nieto FJ Guidry U Lind BK Redline S Pickering TG Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 2001 154 1 50 9 11434366 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    HbA1c increased by 1.49% in mild OSA, 1.93% in moderate OSA, and 3.69% in severe OSA, compared with individuals without OSA.

    “it was found that HbA1c increased by 1.49% in mild OSA, 1.93% in moderate OSA, and 3.69% in severe OSA, compared with individuals without OSA.(106)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Aronsohn RS Whitmore H Van Cauter E Tasali E Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 2010 181 5 507 13 20019340 PMC2830401 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Insomnia, especially when coupled with short sleep duration, is associated with hyperactivity of the HPA axis and sympathetic system and consequently with a clinically significant risk of CVD (e.g., hypertension, type-2 diabetes, myocardial infarction, and coronary heart disease).

    “Insomnia, especially when coupled with short sleep duration, is associated with hyperactivity of the hypothalamic-pituitary-adrenal axis (e.g., increased cortisol secretion) and sympathetic system (e.g., impaired heart rate variability) and, consequently, with a clinically significant risk of CVD (e.g., hypertension, type-2 diabetes, myocardial infarction, and coronary heart disease).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Central obesity is strongly associated with incident sleep-disordered breathing and "poor sleep", but not as much with incident insomnia.

    “for example, central obesity is strongly associated with incident SDB and “poor sleep”, but not as much with incident insomnia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The odds of hypertension in individuals with insomnia who slept <6 hours were 3.5- to 5.1-fold cross-sectionally and 3.8-fold longitudinally.

    “and the odds of hypertension were 3.5- to 5.1-fold cross-sectionally71 and 3.8-fold longitudinally”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [178] Vgontzas AN Liao D Bixler EO Chrousos GP Vela-Bueno A Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009 32 4 491 7 19413143 PMC2663863 source

      Not checked in the free run.

    • cites [179] Vgontzas AN Liao D Pejovic S Calhoun S Karataraki M Bixler EO Insomnia with objective short sleep duration is associated with type 2 diabetes: A population-based study. Diabetes Care 2009 32 11 1980 5 19641160 PMC2768214 source

      Not checked in the free run.

    • cites [180] Fernandez-Mendoza J Vgontzas AN Liao D Shaffer ML Vela-Bueno A Basta M Insomnia with objective short sleep duration and incident hypertension: the Penn State Cohort. Hypertension 2012 60 4 929 35 22892811 PMC3679545 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Shorter sleep duration and worse sleep efficiency were associated with impaired glucose tolerance in a recent study.

    “A recent study showed that shorter sleep duration, as well as worse sleep efficiency, was associated with impaired glucose tolerance (190).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [190] Zhu Y Li AM Au CT Kong AP Zhang J Wong CK Association between sleep architecture and glucose tolerance in children and adolescents. J Diabetes 2015 7 1 10 5 25695111 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Sleep-related factors are important contributors to cardiovascular risk in childhood, including sleep duration and factors that disrupt sleep quality, particularly sleep-disordered breathing.

    “Similar to what has been shown in adults; sleep-related factors are important contributors to cardiovascular risk in childhood. These factors include both sleep duration, as well as factors that disrupt sleep quality, particularly sleep-disordered breathing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Children with sleep-disordered breathing have significantly elevated pulmonary arterial pressures as well as right ventricular hypertrophy and dysfunction.

    “Children with sleep-disordered breathing have significantly elevated pulmonary arterial pressures as well as right ventricular hypertrophy and dysfunction (199).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [199] Anna Theresa Weber S Pierri Carvalho R Ridley G Williams K El Dib R A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy. Int J Pediatr Otorhinolaryngol 2014 78 10 1571 8 25108873 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    While sleep-disordered breathing is strongly associated with metabolic syndrome, the evidence for insomnia is limited and inconsistent.

    “While SDB is strongly associated with the metabolic syndrome (MetS), the evidence for insomnia is limited and inconsistent(63, 183, 184).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [63] Hall MH Okun ML Sowers M Matthews KA Kravitz HM Hardin K Sleep is associated with the metabolic syndrome in a multi-ethnic cohort of midlife women: the SWAN Sleep Study. Sleep 2012 35 6 783 90 22654197 PMC3353036 source

      Not checked in the free run.

    • cites [183] Jennings JR Muldoon MF Hall M Buysse DJ Manuck SB Self-reported sleep quality is associated with the metabolic syndrome. Sleep 2007 30 2 219 23 17326548 source

      Not checked in the free run.

    • cites [184] Kazman JB Abraham PA Zeno SA Poth M Deuster PA Self-reported sleep impairment and the metabolic syndrome among African Americans. Ethn Dis 2012 22 4 410 5 23140070

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The estimated risk for incident myocardial infarction and coronary heart disease associated with "poor sleep" or insomnia ranges between 41% and 55%, respectively.

    “and that for incident myocardial infarction (MI) and coronary heart disease (CHD) between 41% and 55%, respectively(176, 177)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [176] Sofi F Cesari F Casini A Macchi C Abbate R Gensini GF Insomnia and risk of cardiovascular disease: a meta-analysis. European journal of preventive cardiology 2014 21 1 57 64 22942213 source

      Not checked in the free run.

    • cites [177] Li M Zhang XW Hou WS Tang ZY Insomnia and risk of cardiovascular disease: a meta-analysis of cohort studies. Int J Cardiol 2014 176 3 1044 7 25156850 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Most studies on insomnia and cardiovascular disease risk did not include polysomnography and could not control for sleep-disordered breathing.

    “the effect sizes reported were modest and most studies did not include PSG and could not control for SDB.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Many racial/ethnic minority groups, particularly Blacks/African-Americans and Hispanics-Latinos, are at greater risk of obesity, heart disease, diabetes, and cardiovascular events.

    “In particular many racial/ethnic minority groups (particularly Blacks/African-Americans and Hispanics-Latinos) are at greater risk of obesity, heart disease, diabetes, and cardiovascular events (204, 206, 207).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [204] Centers for Disease Control and Prevention CDC Health Disparities and Inequalities Report -- United States, 2011 2011 CDC Atlanta, GA

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [206] Smedley BD Stith AY Nelson AR Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care 2003 xvi 764 National Academy Press Washington, D.C. 25032386

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [207] Ong KL Cheung BM Wong LY Wat NM Tan KC Lam KS Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004. Ann Epidemiol 2008 18 3 222 9 18201902 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some studies have found that sleep quality is worse among racial/ethnic minorities, while others have not.

    “Although some studies have found that sleep quality is worse among racial/ethnic minorities(229-232), others have not(233-235).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [229] Kripke DF Jean-Louis G Elliott JA Klauber MR Rex KM Tuunainen A Ethnicity, sleep, mood, and illumination in postmenopausal women. BMC Psychiatry 2004 4 8 15070419 PMC400740 source

      Not checked in the free run.

    • cites [230] Boss EF Smith DF Ishman SL Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children. Int J Pediatr Otorhinolaryngol 2011 75 3 299 307 21295865 source

      Not checked in the free run.

    • cites [231] Patel NP Grandner MA Xie D Branas CC Gooneratne N “Sleep disparity” in the population: poor sleep quality is strongly associated with poverty and ethnicity. BMC Public Health 2010 10 1 475 20701789 PMC2927542 source

      Not checked in the free run.

    • cites [232] Moore M Kirchner HL Drotar D Johnson N Rosen C Redline S Correlates of adolescent sleep time and variability in sleep time: The role of individual and health related characteristics. Sleep Med 2011 12 3 239 45 21316300 PMC3050885 source

      Not checked in the free run.

    • cites [233] Hale L Rivero-Fuentes E Negative acculturation in sleep duration among Mexican immigrants and Mexican Americans. J Immigr Minor Health 2011 13 2 402 7 19728094 source

      Not checked in the free run.

    • cites [234] Grandner MA Patel NP Gehrman PR Xie D Sha D Weaver T Who gets the best sleep? Ethnic and socioeconomic factors related to sleep disturbance. Sleep Med 2010 11 470 9 20388566 PMC2861987 source

      Not checked in the free run.

    • cites [235] Gellis LA Lichstein KL Scarinci IC Durrence HH Taylor DJ Bush AJ Socioeconomic status and insomnia. J Abnorm Psychol 2005 114 1 111 8 15709817 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Both short sleep duration and sleep-disordered breathing appear to be important modifiable risk factors that contribute towards overall cardiovascular risk in children.

    “Both short sleep duration and sleep-disordered breathing appear to be important modifiable risk factors that contribute towards overall cardiovascular risk.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Racial/ethnic and socioeconomic health disparities are still well-documented in the United States.

    “Although health care advances have proceeded at a dramatic pace over the last half-century, racial/ethnic and socioeconomic health disparities are still well-documented in the United States.(204-206).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [204] Centers for Disease Control and Prevention CDC Health Disparities and Inequalities Report -- United States, 2011 2011 CDC Atlanta, GA

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [205] Adler NE Rehkopf DH U.S. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health 2008 29 235 52 18031225 source

      Not checked in the free run.

    • cites [206] Smedley BD Stith AY Nelson AR Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care 2003 xvi 764 National Academy Press Washington, D.C. 25032386

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In the same 2007-2008 NHANES sample, non-Mexican Hispanics/Latinos were 87% more likely to report very short sleep and 35% more likely to report short sleep.

    “In this same sample, non-Mexican Hispanics/Latinos were 87% more likely to report very short sleep and 35% more likely to report short sleep.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [220] Whinnery J Berkowitz Sturgis EK Staley B Corbitt C Gehrman P Chakravorty S Sleep architecture differences between good sleepers and patients with primary insomnia. SLEEP 2013 36 A212 (Abstract Supplement)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Using the 2007-2008 NHANES, relative to non-Hispanic Whites, Blacks/African-Americans were 3.5 times as likely to report very short (<5 hours) sleep duration and twice as likely to report short (5-6 hours) sleep duration.

    “Using the 2007-2008 NHANES, Whinnery and colleagues(220) found that relative to non-Hispanic Whites, Blacks/African-Americans were 3.5 times as likely to report very short (<5 hours) sleep duration and twice as likely to report short (5-6 hours) sleep duration.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [220] Whinnery J Berkowitz Sturgis EK Staley B Corbitt C Gehrman P Chakravorty S Sleep architecture differences between good sleepers and patients with primary insomnia. SLEEP 2013 36 A212 (Abstract Supplement)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    African-Americans were more likely to have sleep disordered breathing, of greater severity, compared to Whites.

    “Regarding sleep disorders, Ruiter and colleagues(226) found that African-Americans were more likely to have sleep disordered breathing, of greater severity, compared to Whites.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Ruiter ME DeCoster J Jacobs L Lichstein KL Sleep disorders in African Americans and Caucasian Americans: a meta-analysis. Behav Sleep Med 2010 8 4 246 59 20924837 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    A potential explanation for inconsistent relationships between race/ethnicity and sleep symptoms is the variable, interactive roles of race/ethnicity, socioeconomic, and cultural factors.

    “A potential explanation is the variable, interactive roles of race/ethnicity, socioeconomic, and cultural factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the 2007-2008 NHANES sample, Non-Mexican Hispanics/Latinos were more likely to report choking/gasping during sleep and snoring.

    “In this sample, Non-Mexican Hispanics/Latinos were more likely to report choking/gasping during sleep and snoring(228).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [228] Grandner MA Petrov MER Rattanaumpawan P Jackson N Platt A Patel NP Sleep Symptoms, Race/Ethnicity, and Socioeconomic Position. Journal of Clinical Sleep Medicine 2013 9 9 897 905 23997702 PMC3746717 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Underlying pathophysiologic effects of sleep-disordered breathing that may cause these deleterious cardiovascular effects include endothelial dysfunction, autonomic dysfunction, and chronic inflammation.

    “The underlying pathophysiologic effects of sleep-disordered breathing that may cause these deleterious effects include endothelial dysfunction (200), autonomic dysfunction (201), and chronic inflammation (202).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [200] Gozal D Kheirandish-Gozal L Serpero LD Sans Capdevila O Dayyat E Obstructive sleep apnea and endothelial function in school-aged nonobese children: effect of adenotonsillectomy. Circulation 2007 116 20 2307 14 17967978 source

      Not checked in the free run.

    • cites [201] Baharav A Kotagal S Rubin BK Pratt J Akselrod S Autonomic cardiovascular control in children with obstructive sleep apnea. Clin Auton Res 1999 9 6 345 51 10638809 source

      Not checked in the free run.

    • cites [202] Kheirandish-Gozal L Capdevila OS Tauman R Gozal D Plasma C-reactive protein in nonobese children with obstructive sleep apnea before and after adenotonsillectomy. J Clin Sleep Med 2006 2 3 301 4 17410279 PMC1847566 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Asians/Others were 2.5 times as likely to report very short sleep and 67% more likely to report short sleep.

    “And Asians/Others were 2.5 times as likely to report very short sleep and 67% more likely to report short sleep.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [220] Whinnery J Berkowitz Sturgis EK Staley B Corbitt C Gehrman P Chakravorty S Sleep architecture differences between good sleepers and patients with primary insomnia. SLEEP 2013 36 A212 (Abstract Supplement)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Habitual short sleep duration is associated with weight gain and obesity, hypertension, hyperlipidemia, inflammation, diabetes, heart attack, and stroke.

    “Habitual short sleep duration is associated with weight gain and obesity, hypertension, hyperlipidemia, inflammation, diabetes, heart attack, and stroke.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Sleep apnea is a well-characterized risk factor for cardiometabolic morbidity and even cardiovascular events.

    “In particular, sleep apnea is a well-characterized risk factor for cardiometabolic morbidity and even cardiovascular events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Cognitive Behavioral Therapy for Insomnia does not carry the risks of prescription hypnotic medications and is therefore preferable for reasons beyond demonstrated efficacy, efficacy relative to medications, and effectiveness.

    “The recommended first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not carry these risks and is therefore preferable for reasons beyond demonstrated efficacy(244-248), efficacy relative to medications(249-253), and effectiveness(254).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [244] Okajima I Komada Y Inoue D A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms 2011 9 1 24 34

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [245] Murtagh DR Greenwood KM Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol 1995 63 1 79 89 7896994 source

      Not checked in the free run.

    • cites [246] Irwin MR Cole JC Nicassio PM Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 2006 25 1 3 14 16448292 source

      Not checked in the free run.

    • cites [247] Morin CM Culbert JP Schwartz SM Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994 151 8 1172 80 8037252 source

      Not checked in the free run.

    • cites [248] Mitchell MD Gehrman P Perlis M Umscheid CA Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract 2012 13 40 22631616 PMC3481424 source

      Not checked in the free run.

    • cites [249] McClusky HY Milby JB Switzer PK Williams V Wooten V Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia. Am J Psychiatry 1991 148 1 121 6 1888345 source

      Not checked in the free run.

    • cites [250] Jacobs GD Pace-Schott EF Stickgold R Otto MW Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 2004 164 17 1888 96 15451764 source

      Not checked in the free run.

    • cites [251] Smith MT Perlis ML Park A Smith MS Pennington J Giles DE Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002 159 1 5 11 11772681 source

      Not checked in the free run.

    • cites [252] Morin CM Colecchi C Stone J Sood R Brink D Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 1999 281 11 991 9 10086433 source

      Not checked in the free run.

    • cites [253] Sivertsen B Omvik S Pallesen S Bjorvatn B Havik OE Kvale G Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006 295 24 2851 8 16804151 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Knowledge about the existence of Cognitive Behavioral Therapy for Insomnia is limited in the medical community, and providers may be difficult to locate.

    “Despite this, knowledge about the existence of CBTI is limited in the medical community, and providers may be difficult to locate(255).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [255] Thomas A Grandner M Nowakowski S Nesom G Corbitt C Perlis ML Where are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment. Behav Sleep Med 2016 1 12 PMC5070478 27159249

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The recommended first line treatment for insomnia is not pharmacotherapy, although pharmacotherapy remains the most widely-utilized approach.

    “Of note, the recommended first line treatment for insomnia is not pharmacotherapy, although pharmacotherapy remains the most widely-utilized approach(238).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [238] Moloney ME Konrad TR Zimmer CR The medicalization of sleeplessness: a public health concern. Am J Public Health 2011 101 8 1429 33 21680913 PMC3134490 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Studies that evaluated the prevalence of sleep apnea in obesity, cardiology, and diabetes clinics routinely find that most patients meet criteria for sleep apnea, though few are diagnosed and even fewer are successfully treated.

    “Strikingly, as described above, studies that evaluated the prevalence of sleep apnea in obesity, cardiology, and diabetes clinics routinely find that most patients meet criteria for sleep apnea, though few are diagnosed and even fewer are successfully treated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Prospective studies show that insufficient sleep is a risk factor for incident obesity, hypertension, and diabetes.

    “In addition to many cross-sectional studies, prospective studies show that insufficient sleep is a risk factor for incident obesity, hypertension, and diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Sleep apnea is associated with cardiac and vascular dysfunction, hypertension, dyslipidemia, diabetes, inflammation, heart attack and stroke.

    “Sleep apnea is associated with cardiac and vascular dysfunction, hypertension, dyslipidemia, diabetes, inflammation, heart attack and stroke.”
    Quote in the paperSubstantial claim
56 of 56

  • The paper relies on this without support.

    Sleep hygiene therapy alone is not effective in the treatment of insomnia.

    “Interestingly, however, sleep hygiene therapy alone, which targets poor health behaviors, is not effective in the treatment of insomnia.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The relationship between longer sleep duration and mortality has been reported in previous reviews and meta-analyses.

    “The relationship between longer sleep duration and mortality, while unexpected, has been reported in previous reviews and meta-analyses”

    From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [214]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • NHANES prevalence claim cites a report on different data

    Minor

    The cited reference is titled as a report about 12 states in 2009, not the two 2005-2008 NHANES survey cycles identified in the claim.

  • Shankar finding is cited to a Rafalson paper

    Minor

    Reference 62 names Rafalson and colleagues, not Shankar and colleagues, as its authors.

  • Racial sleep-duration claim cites an insomnia study

    Minor

    The claim attributes a 2007-2008 NHANES racial comparison to reference 220, whose listed title concerns sleep architecture in good sleepers and patients with primary insomnia.

  • Very short sleep is given opposite thresholds

    Minor

    The lipids section describes very short sleep as more than five hours, whereas the paper later defines it as less than five hours.

4 of 4

Cites

Flagged first, then by citations

9 of the 262 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Whinnery, 2013, Sleep architecture differences between good sleepers and patients with primary insomnia, Sleep, 36, A212

Cited by

Sorted by citations

Related

Authors
Grandner, M. A., Alfonso-Miller, P., Fernandez-Mendoza, J., Shetty, S., Shenoy, S., & Combs, D.
Affiliations
Pennsylvania State University (US)
Corresponding author
Grandner, Michael A.
ORCID
Venue
Current Opinion in Cardiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-09
Volume
31
Issue
5
Pages
551-565
ISSN
0268-4705 (ISSN-L)
DOI
10.1097/hco.0000000000000324
PMC
PMC5056590
OpenAlex
W2481881625
Semantic Scholar
9fbf43ca7f74eadc5139794bb110bc94874846b2
Cited by
166
References
262
Citations by year
2026: 13 · 2025: 27 · 2024: 24 · 2023: 20 · 2022: 22 · 2021: 15 · 2020: 12 · 2019: 18 · 2018: 7 · 2017: 8
FWCI
1.45
Type
journal article
Language
en
Open access
Locations
  • Current Opinion in Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Northumbria Research Link (Northumbria University) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K23HL110216)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
sleep, sleep disorders, cardiometabolic disease, cardiovascular disease, insufficient sleep duration, insomnia, sleep apnea, obesity, inflammation, diabetes mellitus, cardiovascular mortality, pediatric sleep disorders, cardiovascular health disparities
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Humans, Obesity, Risk Factors, Sleep, Sleep Wake Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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