Sleep disturbance, especially chronic partial sleep loss, has been linked to problems with the cardiovascular system, including heart attack, irregular heartbeat, and stroke. Several epidemiologic surveys show a strong association between sleep complaints or shortened sleep durations and cardiovascular disease (20, 21 and 22). One study of Japanese workers found that individuals who slept less than 5 hours a night had a threefold increased risk of heart attacks (23).

Patients with coronary heart disease have more complaints of disturbed sleep than patients without coronary heart disease (24, 25 and 26). Sleep-disordered breathing has been shown to increase the risk of cardiovascular disease and stroke (27,28). Previous data have shown associations between OSA and cardiovascular morbidity, including systemic and pulmonary hypertension, left ventricular dysfunction, coronary artery disease, arrhythmias, CHF, and coronary heart disease (29,30). Potential mechanisms mediating hypertension include enhanced chemoreceptor sensitivity inducing excessive daytime sympathetic vasoconstrictor activity (29). There is some evidence to indicate that the increased vascular risk may be related to inflammation. For example, C-reactive protein (CRP) increases under both total and chronic partial sleep deprivation conditions (31) and has been found to be elevated in patients with OSA (32). Sleep disturbances are also common in patients with CHF (19). Sleep complaints include difficulty falling asleep as well a frequent nocturnal arousals, often associated with nocturnal dyspnea. Patients with CHF have a high prevalence of sleep-disordered breathing of the obstructive and central types (33). It has long been recognized that Cheyne-Stokes respirations (central sleep apneas) is a common cause of nocturnal dyspnea in CHF (34). Th erefore, optimizing the treatment of CHF and sleep-disordered breathing can improve sleep in patients with CHF (26).

Sleep is an important modulator of appetite and metabolism. Shortened sleep duration has been shown to alter leptin and ghrelin levels, which in turn stimulate appetite and may in part explain the association between increased weight and short
sleep duration (35,36). These findings are particularly relevant in modern societies, where chronic sleep restriction is common and food is readily available 24-7.

Sleep disturbances are common among individuals with diabetes. When compared to nondiabetics, patients with diabetes reported higher rates of insomnia and excessive daytime sleepiness (37,38). As much as 71% of this population report poor sleep quality (39). A number of factors contribute to sleep complaints in patients with diabetes. It has also been postulated that in patients with type I diabetes, rapid changes in glucose levels during sleep cause awakenings and complaints of insomnia (40). For individuals with adult-onset diabetes, sleep disturbances may be related to obesity and obesity-related sleep disorders such as OSA (41). Sleep-disordered breathing correlates highly with obesity in the diabetic population (41). However, independent of obesity, OSA is associated with impaired glucose tolerance, insulin resistance, and hypertension (41, 42 and 43). In addition, there is a correlation between the severity of sleep apnea and the severity of impaired glucose metabolism, insulin resistance, and diabetes (43,44).

Other common sources of disturbed sleep in diabetics include chronic discomfort or pain associated with diabetic peripheral neuropathy and RLS (45). Chronic pain, restless legs, and periodic leg movements can cause or exacerbate complaints of difficulty falling asleep and staying asleep (46). A thorough assessment of sleep quality and treatment of specific sleep disorders, such as sleep apnea and restless legs, can improve the management of metabolic disorders.

Sleep-disordered breathing (primarily in the form of OSA) is often seen in patients with COPD. Therefore, a large number of patients are likely to have the “overlap syndrome” of having both OSA and COPD, which can result in more severe nocturnal hypoxemia than either condition alone (47). Sleep quality is often poor in patients with COPD (48). Impairment of pulmonary function was associated with decreased total sleep time and decreased sleep efficiency (49). Sleep can have significant negative effects on respiration in patients with respiratory compromise, resulting in hypoxemia and hypercapnia (50), which in turn can disturb sleep. Chronic dyspnea and sleep-related hypoxemia likely contribute to the disturbed sleep of patients with COPD. Therefore, therapies such as bronchodilators and nocturnal oxygen supplementation may also improve sleep quality (33,50). In addition to impaired pulmonary function and nocturnal hypoxemia, OSA and other sleep disorders such as insomnia and RLS are common in older patients with COPD and likely contribute to the higher prevalence of sleep complaints in this population (48).

Adults with asthma have more complaints of restless sleep and sleepiness than those without asthma (51,52). Sleep can be disrupted by asthma attacks, which occur more frequently in the second half of the night, during REM sleep (52,53). The presence of OSA and gastroesophageal reflux should also be considered in patients with nocturnal worsening of asthma (33). Therefore, all patients with asthma should be asked about their sleep quality and symptoms of OSA, which can further disrupt sleep and cause hypoxemia during sleep.

Patients with GI disorders have a higher prevalence of sleep disorders as compared to the general population (54)

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