Review Article
Tick–tock–tick–tock: the impact of circadian rhythm disorders on cardiovascular health and wellness

https://doi.org/10.1016/j.jash.2014.08.011Get rights and content

Abstract

Humans spend a third of their lives asleep. A well–balanced synchrony between sleep and wakefulness is needed to maintain a healthy lifestyle. Optimal sleep is based on an individual's inherent sleep requirement and circadian rhythm. If either one or both of these critical elements are disrupted, daytime dysfunction, non–restorative sleep, and/or reduced sense of well-being may result. While the medical community is more familiar with sleep disorders such as sleep apnea, insomnia, and narcolepsy, circadian rhythm sleep wake disorders (CRSWDs) are less known, despite these being common within the general population. CRSWDs are comprised of the following: shiftwork disorder, delayed sleep phase disorder, advanced sleep phase disorder, jet lag disorder, non–24–hour sleep–wake disorder, and irregular sleep–wake rhythm disorder. In general, a CRSWD results when there is misalignment between the sleep pattern and the desired sleep schedule, dictated by work, family, and social schedules. Subsequently, patients have difficulty falling asleep, maintaining sleep, and/or experience poor quality sleep predisposing them to insomnia or excessive sleepiness. In this article, we review the core concepts related to sleep, and sleep deprivation in the context of CRSWDs.

Section snippets

Background: The Delicate Interplay of Sleep and Circadian Drive

Healthy sleep must include the optimization of an individual’s sleep quality and quantity. To achieve this, an individual must avail themselves with an adequate sleep opportunity that occurs in line with his/her natural sleep–wake pattern. An individual’s optimal sleep timing and duration depends upon factors such as age and gender, and varies from individual to individual depending upon genetic and physiological factors.1

The sleep need varies across age groups and is impacted by lifestyle and

Summary

The human body requires adequate sleep quality and quantity to function optimally during daytime. The internal clock within the human body maintains our regular rhythm, specifically designating our natural sleep initiation and termination times. This rhythm can be disrupted from an internal change or from an external change such as working night–time shifts, resulting in CRSWDs. Patients with CRSWDs experience excessive daytime sleepiness, fatigue, and other sleep symptoms due to lack of

References (78)

  • I. Ahmed et al.

    Clinical features, diagnosis and treatment of narcolepsy

    Clin Chest Med

    (2010)
  • C. Gamaldo et al.

    The sleep-immunity relationship

    Neurol Clin

    (2012)
  • M. Uetani et al.

    The influence of being overweight on the relationship between shift work and increased total cholesterol level

    Ann Epidemiol

    (2011)
  • A.M. Schroeder et al.

    How to fix a broken clock

    Trends Pharmacol Sci

    (2013)
  • S.M. Rajaratnam et al.

    Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomized controlled multicenter trials

    Lancet

    (2009)
  • O. Tochikubo et al.

    Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder

    Hypertension

    (1996)
  • K. Spiegel et al.

    Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite

    Ann Intern Med

    (2004)
  • F.P. Cappuccico et al.

    Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies

    Eur Heart J

    (2011)
  • E. Lurbe et al.

    Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes

    N Engl J Med

    (2002)
  • D.E. Ayala et al.

    Circadian pattern of ambulatory blood pressure in hypertensive patients with and without type 2 diabetes

    Chronobiol Int

    (2013)
  • S. Isobe et al.

    Disturbed circadian rhythm of intrarenal renin-angiotensin system: relevant to nocturnal hypertension and renal damage

    Clin Exp Nephrol

    (2014)
  • d Gottlieb et al.

    Association of unusual sleep duration with hypertension: the Sleep Heart Health Study

    Sleep

    (2006)
  • M.P. Hoevenaar-Blom et al.

    Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGAN study

    Sleep

    (2011)
  • I. Merikanto et al.

    Association of chronotype and sleep with cardiovascular disease and type 2 diabetes

    Chronobiol Int

    (2012)
  • C. Hublin et al.

    Genetic factors in evolution of sleep length: a longitudinal twin study in Finnish adults

    J Sleep Res

    (2013)
  • M.H. Bonnet et al.

    We are chronically sleep deprived

    Sleep

    (1995)
  • T. Nuutinen et al.

    Do computer use, TV viewing, and the presence of the media in the bedroom predict school-aged children’s sleep habits in a longitudinal study?

    BMC Public Health

    (2013)
  • W. Sroykham et al.

    Effect of LED-backlit computer screen and emotional self regulation on human melatonin production

    Conf Proc IEEE Eng Med Biol Soc

    (2013)
  • K.M. Awad et al.

    Effect of exercise and nutritional intake on sleep architecture in adolescent

    Sleep Breath

    (2013)
  • A.A. Borbély

    A two process model of sleep regulation

    Hum Neurobiol

    (1982)
  • D.J. Kennaway et al.

    Development of melatonin production in infants and impact of prematurity

    J Clin Endocrinol Metab

    (1992)
  • K.L. Armstrong et al.

    The sleep patterns of normal children

    Med J Aust

    (1994)
  • M.A. Carskadon et al.

    Association between puberty and delayed phase preference

    Sleep

    (1993)
  • H.L. Chiang et al.

    Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders

    J Sleep Res

    (2010)
  • A. Khullar

    The role of melatonin in the circadian rhythm sleep-wake cycle

    Psychiatric Times

    (2012)
  • I. Tsaousis

    Circadian preferences and personality traits: a meta-analysis

    Eur J Pers

    (2010)
  • AASM - advanced sleep phase syndrome. Available at: http://www.aasmnet.org/resources/factsheets/crsd.pdf. Accessed...
  • D. Maestripieri

    Night owl women are similar to men in their relationship orientation, risk-taking propensities, and cortisol levels: implications for the adaptive significance and evolution of eveningness

    Evol Psychol

    (2014)
  • G. Linguori et al.

    Semester-long changes in sleep duration for college students

    College Student Journal

    (2011)
  • Cited by (17)

    • Cardiovascular diseases: a therapeutic perspective around the clock

      2020, Drug Discovery Today
      Citation Excerpt :

      In fact, a considerable portion of the population around the world does not achieve the recommended 7–8 h of sleep.1. Evidence has suggested that poor or short sleeping habits (i.e., <6.5 h of sleep per night) lead to increased BP and HR in healthy individuals 1,24 and is associated with increased morbidity and mortality, mainly from CVD.25 At a molecular level, sleep deprivation was shown to alter diurnal gene expression in mice, resulting in altered gene expression in the heart and lungs.26

    • Circadian clock genes and myocardial infarction in patients with type 2 diabetes mellitus

      2019, Gene
      Citation Excerpt :

      People with diabetes usually have a higher heart rate in sleep and lower heart rate variability over the day than non-diabetics, which causes unnecessary oxygen consumption in the myocardium with reduced blood supply (Boras and Ljubičić, 2009; Paneni et al., 2013). It was noted that hypertensive patients with type 2 diabetes have a two-fold increase in blood pressure than hypertensive patients without diabetes (Gamaldo et al., 2014). Within the regulation of diabetes in humans, it is crucial to control circadian glucose metabolism, and changes in the standard cyclic pattern of glucose tolerance are characteristic for type 2 diabetes (Green et al., 2008).

    • Circadian Rhythm Disorders Aggravate Periodontitis by Modulating BMAL1

      2023, International Journal of Molecular Sciences
    View all citing articles on Scopus

    Conflict of interest: none.

    View full text