Association between self-reported sleep characteristics and cardiovascular risk factors: Weight status and physical activity matter

We analysed the association between self-reported sleep characteristics and the prevalence of major cardiovascular disease (CVD) risk factors attending to the potential effect of physical activity (PA) and weight status. A large cohort of Spanish workers (n = 527,662; 32% female, 44 ± 9yrs) participated in this cross-sectional study. We assessed participants' self-reported indicators of sleep quantity (short [<6 h/d], normal [6-9 h/d] or long [>9 h/d]) and quality (unrestful or restful, and difficulties or not falling asleep) as well as the presence of major CVD risk factors (diabetes, hypertension and hypercholesterolemia); and categorised participants based on PA ("inactive", "insufficiently active" or "regularly active") and weight status (normal weight, overweight or obesity). Impairments in any sleep quantity or quality indicator, respectively, were significantly (p < 0.05) associated with the prevalence of at least one CVD risk factor. Yet, being physically active and having normal weight markedly attenuated these associations. Thus, individuals with poor sleep quantity or quality but who were physically active and had normal weight showed no different risk of hypertension or diabetes than those with normal sleep characteristics, albeit the former still presented a higher risk of hypercholesterolemia if they reported short sleep (+5% vs. normal duration, p = 0.047), unrestful sleep (+9% vs. restful, p < 0.001) or having difficulties to fall asleep (+48% vs. no difficulties, p < 0.001). The present findings support the need for maintaining optimal PA levels and weight status in order to minimise the CVD risk associated with poor sleep quantity or quality.HighlightsBoth sleep quantity and quality are associated with the prevalence of hypertension, diabetes, and hypercholesterolemia.Being physically active and having normal weight markedly reduces the cardiovascular risk associated with poor sleep quantity/quality.Having poor sleep quantity/quality while being also inactive and overweight/obese predisposes to a higher cardiovascular risk.