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Constant stress conditions may be detrimental in the long run, and not only in terms of well-being. With normal stress levels, good and normal sleep at night should be able to restore energy levels and personal resources, as well as counteract the emotional loads induced by daytime stress.1 But what good can happen when sleep duration decreases? While the US National Institutes of Health suggest that healthy adults should sleep 7 to 8 hours, it has been established that the mean sleep duration has decreased slightly and the percentage of adults sleeping 6 hours or less has increased by 31% between 1985 and 2012 in the USA.2

Not only is insufficient sleep duration prevalent in the population, it is also associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly prevalent and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration.3
Associated with stress, impaired sleep also has cardiovascular consequences. Indeed, it has been shown in a 2019 study conducted in Germany that the risk for coronary artery disease and cardiovascular diseases was increased in hypertensive people with work stress and impaired sleep, free of any cardiovascular disease and diabetes. The absolute cardiovascular disease mortality rate was more than double in people with combined stress conditions and impaired sleep, compared with the reference group.1

With stress and poor sleep conditions now acknowledged as risk factors for cardiovascular diseases, new types of interventions are being considered.1, 3 Lifestyle changes have for a long time been part of the armamentarium against cardiovascular conditions: dietary changes, smoking cessation, physical activities are well-known components of the management of those diseases, alongside medical treatments or on their own.4

Good sleep quality could be associated with lower cardiovascular risks, and new, stress-improving treatment avenues are now being considered to reduce cardiovascular risk.3 Relaxation, through yoga or meditation, show promises as new, soft lifestyle tools in the management of metabolic and heart conditions.5, 6 Even though the overall quality and, in some cases, quantity of study data are modest, the American Heart Association concludes that meditation has, indeed, a possible benefit on cardiovascular risk. They also add that “Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification”, while asserting that “further research on meditation and cardiovascular risk is warranted.”6

In 2017, in an analysis of twelve studies, an American team has focused on the impact of yoga, a mind-body exercise, utilizing breathing techniques with low-impact physical activity as an alternative treatment for cardiovascular disease. Their conclusion was that yoga has “clear potential […] as an alternative and complementary means to improve cardiovascular disease risk.”7

In many therapeutic areas, individualized treatments are the way forward. Lifestyle intervention themselves are subject to this phenomenon. The range of lifestyle interventions expands, increasing the options available to patients. Relaxation methods, yoga or meditation, are a welcome addition to more traditional interventions such as smoking cessation, diet, and exercise strategies. For a current smoker, successfully quitting smoking is the most effective lifestyle change, but smoking cessation has only a small probability of success. Indeed, tobacco cessation or dietary measures can sometimes be felt like a deprivation by patients, taking away a part of their previous lifestyle. On the other hand, yoga’s soft approach and accessibility could make it one of the strongest lifestyle interventions for reducing cardiovascular risk, and probably one with a low cost.5

References

  1. Li J, Atasoy S, Fang X, Angerer P, Ladwig KH. Combined effect of work stress and impaired sleep on coronary and cardiovascular mortality in hypertensive workers: The MONICA/KORA cohort study. Eur J Prev Cardiol. 2019:2047487319839183. [Epub ahead of print]
  2. Ford ES, Cunningham TJ, Croft JB. Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012. Sleep. 2015;38(5):829-32.
  3. Grandner MA, Alfonso-Miller P, Fernandez-Mendoza J, et al. Sleep: important considerations for the prevention of cardiovascular disease. Curr Opin Cardiol. 2016;31(5):551-65.
  4. Haskell WL. Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy. J Cardiovasc Nurs. 2003 t;18(4):245-55.
  5. Chu P, Pandya A, Salomon JA, et al. Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction. J Am Heart Assoc. 2016;5(3):e002737.
  6. Levine GN, Lange RA, Bairey-Merz CN, D, et al. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017;6(10). pii: e002218.
  7. Haider T, Sharma M, Branscum P. Yoga as an Alternative and Complimentary Therapy for Cardiovascular Disease: A Systematic Review. J Evid Based Complementary Altern Med. 2017;22(2):310-316.