Is Poor Sleep Health Associated with Arterial Stiffness in Midlife Women: A Narrative Review

The menopausal transition, under the larger umbrella of the midlife period in women, occurs in conjunction with chronological aging and accelerates vascular aging. The influence of sleep, specifically insufficient sleep health, on key markers of vascular aging, such as arterial stiffness remains unclear, in midlife women. The objective of this narrative review was to summarize and synthesize existing literature examining the relationship between sleep health measures and arterial stiffness experienced in midlife women. A secondary focus was to review whether the identified studies examined race as a moderator in the relationship. A comprehensive literature search was conducted using Ovid Medline, Elsevier Embase, and references in identified manuscripts to synthesize and evaluate current literature in midlife women, relationship between sleep health domains and Pulse Wave Velocity (PWV), a gold-standard measure of arterial stiffness. Only two studies were longitudinal; the rest were cross-sectional, with most using brachial-ankle PWV (baPWV) to measure arterial stiffness. Overall, identified studies in midlife women found sleep domains like duration and quality were associated with baPWV, indicating an elevated risk of arterial stiffness. Most studies assessing other PWV measures (cfPWV and faPWV) also reported associations between sleep and arterial stiffness. Studies examining only sleep duration and arterial stiffness used the Pittsburgh Sleep Quality Index (PSQI), while those focused on sleep quality used the PSQI or fatigue-related Berlin. Objective sleep quality methods included body-worn actigraphy devices. Objective methods included actigraphy devices. While most identified studies found an association between sleep duration/quality and PWV in midlife women, many cross-sectional designs could not establish causation. Studies were limited in assessing race as a moderator in the association between sleep and arterial stiffness. Results from this review suggests more longitudinal studies are warranted to explore causal links between poor sleep and arterial stiffness in midlife women, particularly in multi-racial cohorts. Understanding the intersection of racial, societal, environmental, and physical factors in women during this transitional period, and how they impact sleep and arterial stiffness (vascular aging) is of public health significance. This knowledge may inform tailored preventative healthcare solutions to reduce CVD risk and improve quality of life in women.