Sleep and Cardiometabolic Health: A Narrative Review of Epidemiological Evidence, Mechanisms, and Interventions

Abstract

Background: Short or poor-quality sleep can disrupt glucose metabolism, blood pressure regulation, appetite hormones, and inflammatory pathways, potentially accelerating weight gain, atherosclerosis, and insulin resistance. However, this multidimensional role of sleep in cardiometabolic disease prevention and management remains underappreciated. Existing literature has not fully synthesized how various aspects of sleep influence the spectrum of cardiometabolic conditions, nor how improving sleep might confer health benefits. Objective: This narrative review examines epidemiological evidence linking sleep health to cardiometabolic outcomes, elucidates biological mechanisms underlying these associations, and discusses interventions aimed at optimizing sleep for cardiometabolic benefit. Methods: We searched and reviewed recent studies and meta-analyses on sleep duration, sleep quality, insomnia, obstructive sleep apnea (OSA), and circadian disruption in relation to obesity, metabolic syndrome, diabetes, cardiovascular diseases, and mortality. Findings: Abnormal sleep patterns are consistently associated with elevated risks of obesity, type 2 diabetes, hypertension, cardiovascular events, and all-cause mortality. Habitual short sleep predicts higher incidence of metabolic syndrome and type 2 diabetes, while chronic insomnia is linked to 45% greater odds of developing or dying from cardiovascular disease. Conversely, healthy sleep-typically 7-9 hours of regular, high-quality sleep per night-is associated with favorable cardiometabolic profiles and has been added to public health cardiovascular metrics. Mechanistically, inadequate sleep provokes insulin resistance, sympathetic overactivity, hormonal appetite changes, and systemic inflammation, which synergistically promote cardiometabolic disease. Conclusion: Prioritizing healthy sleep habits and treating sleep disorders should become integral to lifestyle medicine for cardiometabolic health. Emerging intervention trials suggest that extending sleep or treating OSA can modestly improve weight control, glycemic regulation, and blood pressure.

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