Sleeping well is as important for the heart and brain as not smoking, exercising, controlling cholesterol and blood pressure, among others. A new guideline from the North American Heart Association (AHA) has included sleep habits among risk factors for diseases such as heart attacks and strokes. In an article published in the journal Circulation, the board of directors of the college, which influences medical societies around the world, considers that after 12 years of evaluations and 2,400 scientific studies on the subject, the relationship between the quality nocturnal rest and cardiovascular health is well established.
Twelve years ago, the AHA created a list of essential measures to prevent cardiovascular disease, which until then was called Life’s Simple 7 . With the update, the strategies increase to eight. (See s.) According to the association, over the past two decades, studies have determined that more than 80% of events affecting the heart and brain can be prevented by a healthy lifestyle. This includes getting enough sleep on a regular basis.
“Each person has their own sleep schedule and rhythm, but sleeping less than seven hours a night, going to bed after midnight and waking up before 4 a.m. or after 9 a.m. is already considered pathological,” points out José Netto, otolaryngologist. sleep. “The new metric of sleep duration (from seven to nine hours) reflects the latest scientific findings: sleep affects overall health, and people with healthier habits more effectively manage health indicators such as weight, blood pressure or diabetes risk. type 2,” AHA President Donald M. Lloyd-Jones said in a statement.
Cardiovascular diseases are the most killer in Brazil and in the world and are associated with a series of risk factors. With the exception of family history, the agents that influence heart and brain health are lifestyle-related and therefore modifiable. Therefore, doctors emphasize the importance of sleep hygiene: measures such as going to bed and getting up at the same times, avoiding alcoholic beverages and heavy meals at night, turning off your cell phone and not looking at the television in bed.
Even in cases of snoring and sleep apnea – when there is an interruption in breathing for more than 10 seconds – it is possible to reverse the symptoms with a few simple interventions. According to José Netto, apnea increases the risk of cardiovascular events by 12 times and can be prevented by combating smoking and obesity, which are also risk factors for heart attack and stroke. In cases involving anatomical dysfunctions, surgical procedures or the use of devices can provide the correction. “The important thing is not to ignore apnea or snoring. The impact on health is very important”, he underlines.
INTEGRAL LOOK Thoroughly studied, the relationship between sleep quality and the risk of disease — not just cardiovascular disease — has multiple explanations. The studies that have found the association are observational, that is, they do not establish cause and effect. However, Antonio Carlos Chagas, cardiologist at Hcor, in São Paulo, explains that the physiological processes triggered by the lack of adequate rest can compromise heart and brain health. “For example, people with apnea, especially those who are obese and hypertensive, have altered oxygen levels. Without sleep, you wake up tired and irritated, which can produce arrhythmias,” he says.
Chagas explains that the inclusion of sleep habits in the AHA guidelines indicates that this factor alone increases the risk of cardiovascular disease. However, the cardiologist points out that an accumulation of vulnerabilities, such as smoking, being overweight, diabetes 2, high cholesterol or hypertension, is even more dangerous. “The whole is very important. But, on its own, the quality of sleep also provides an important clue for thinking about prevention”, specifies the doctor, noting that the North American publication has a particularly educational character.
For Luciano Drager, cardiologist at the Brazilian Society of Cardiology (SBC), the main merit of the AHA publication is to look at the patient as a whole, emphasizing that different aspects of the routine, such as eating habits, physical activity and pattern sleep, influence cardiovascular health. “When the various risk factors are controlled, the greater the longevity”, he specifies. Drager, who chairs the Brazilian Sleep Association (ABS), says the expansion of protective measures offered by the American collegiate promotes the importance of good sleep.
In 2018, the doctor was the first author of an article published in the journal Arquivos Brasileiros de Cardiologia defending the importance of sleep quality in cardiovascular health. “Many people, especially younger people, think sleep is a waste of time. In fact, sleep deprivation influences the quality and quantity of life,” says Drager.
Professor of cardiology at Unb and head of Pa do Sírio-Lebanês, at BSB
Sleep should be part of the control
“What studies have observed is that heart attacks and strokes are more common in people with irregular and non-restorative sleep. We already know that the incidence of these two conditions is higher in the morning. , and this has to do with the circadian cycle. In the morning, there is a greater release of cortisol, with an increase in blood pressure. Irregular sleep alters the circadian cycle. It is not yet known whether there is a cause and effect relationship, but there is, yes, an increase in heart risk. In clinics, sleep analysis should be done routinely. Doctors should raise the issue, understand the patient’s sleep routine and guide him in sleep hygiene: sleeping and waking up at the same times and, when falling asleep, not staring at the cell phone, television, etc.
Guideline adjusted to new habits
The American Heart Association (AHA) publication also updated pre-existing guidelines, as well as including sleep pattern as an indicator of healthy lifestyle. Among them is the inclusion of electronic cigarettes as a cardiovascular risk factor. “In 2010, when it was first published, we only talked about nicotine, because the electronic cigarette did not exist. But studies show that this device is not as innocent as we thought: it is very addictive and brings many harms”, underlines Luciano Drager, cardiologist at the Brazilian Society of Cardiology (SBC). The AHA now considers that second-hand smoke (non-smokers exposed to cigarettes) can affect the heart and brain.
The blood lipid measurement was also updated, which began to point to non-HDL cholesterol (the “bad cholesterol”), instead of total, as preferred. Indeed, in addition to not requiring fasting for blood collection, it is easier to calculate. The AHA also suggests changes in blood sugar readings. “An interesting question is that the AHA considers these parameters to be valid for children from the age of 2 already,” points out Drager. “Many children today have high cholesterol.”
Each component of the list prepared by the North American college, called Life’s Essential 8, is evaluated by a tool, available, in English, on the Association’s website (https://mlc.heart.org). There is a scoring system from zero to 100, with scores below 50 indicating poor cardiovascular health; 50-79 moderate, and above 80, high.
“Life’s Essential 8 is a major advance in our ability to identify when cardiovascular health can be preserved and when it is suboptimal,” AHA President Donald M. Lloyd-Jones said in a statement. “We must focus our efforts on improving cardiovascular health for everyone and at all stages of life,” he concluded.
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