Sleep, Stress, and Heart Disease



It is estimated that sleep problems affect around 20% of the adult population in the Western countries.1,2 It has been shown that the short-term consequences of sleep problems lead to adverse physiological changes,3 as well as to long-term health consequences. In experimental and epidemiological studies, both short and long sleep hours have been related to hypertension,4 type-2 diabetes,5,6 increased body mass index (BMI),7 alterations in blood lipids,8 and inflammatory markers9 – all factors known to increase the risk of cardiovascular disease.


Brain metabolism Glucose changes Heart disease Rapid eye ­movement sleep (REM) Risk factors Sleep Sleep disorders Stress 


  1. 1.
    NSF. Sleep in America Poll. Washington DC: National Sleep Foundation; 2002.Google Scholar
  2. 2.
    Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255-1273.PubMedGoogle Scholar
  3. 3.
    Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435-1439.PubMedCrossRefGoogle Scholar
  4. 4.
    Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006;47(5):833-839.PubMedCrossRefGoogle Scholar
  5. 5.
    Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Sleep duration as a risk factor for ­diabetes incidence in a large U.S. sample. Sleep. 2007;30(12):1667-1673.PubMedGoogle Scholar
  6. 6.
    Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care. 2006;29(3):657-661.PubMedCrossRefGoogle Scholar
  7. 7.
    Stranges S, Cappuccio FP, Kandala NB, et al. Cross-sectional versus prospective associations of sleep duration with changes in relative weight and body fat distribution: the Whitehall II Study. Am J Epidemiol. 2008;167(3):321-329.PubMedCrossRefGoogle Scholar
  8. 8.
    Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic ­syndrome. Sleep Med Rev. 2005;9:211-224.PubMedCrossRefGoogle Scholar
  9. 9.
    Vgontzas AN, Zoumakis E, Bixler EO, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab. 2004;89(5):2119-2126.PubMedCrossRefGoogle Scholar
  10. 10.
    Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290(7):891-897.PubMedCrossRefGoogle Scholar
  11. 11.
    Gallicchio L, Kalesan B. Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res. 2009;18:148-158.PubMedCrossRefGoogle Scholar
  12. 12.
    McEwen BS. Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load [Suppl 2]. Metabolism. 2006;55:S20-S23.PubMedCrossRefGoogle Scholar
  13. 13.
    Carskadon MA, Dement WC. Normal human sleep: an overview. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. 3rd ed. Philadelphia: W.B. Saunders Company; 2000:15-25.Google Scholar
  14. 14.
    Rechtschaffe A, Kales A. A manual of standardized terminology, techniques and scoring ­system for sleep stages of human subjects. Bethesda: US Department of Health, Education and Welfare, Public Health Service; 1968.Google Scholar
  15. 15.
    Borbély AA. A two-process model of sleep regulation. Hum Neurobiol. 1982;1:195-204.PubMedGoogle Scholar
  16. 16.
    Åkerstedt T, Folkard S, Portin C. Predictions from the three-process model of alertness. Aviat Space Environ Med. 2004;75:A75-A83.PubMedGoogle Scholar
  17. 17.
    Porkka-Heiskanen T. Adenosine in sleep and wakefulness. Ann Med. 1999;31(2):125-129.PubMedCrossRefGoogle Scholar
  18. 18.
    Saper CB, Chou TC, Scammell TE. The sleep switch: hypothalamic control of sleep and ­wakefulness. Trends Neurosci. 2001;24(12):726-731.PubMedCrossRefGoogle Scholar
  19. 19.
    Webb WB, Agnew HW Jr. Stage 4 sleep: influence of time course variables. Science. 1971;174:1354-1356.PubMedCrossRefGoogle Scholar
  20. 20.
    Horne JA. Functional aspects of human slow wave sleep. In: Wauquier A, Dugovic C, Radulovacki M, eds. Slow Wave Sleep. Physiological, Pathophysiological, and Functional Aspects. New York: Raven Press; 1989:109-119.Google Scholar
  21. 21.
    Saper CB, Lu J, Chou TC, Gooley J. The hypothalamic integrator for circadian rhythms. Trends Neurosci. 2005;28(3):152-157.PubMedCrossRefGoogle Scholar
  22. 22.
    Foret J, Lantin G. The sleep of train drivers: an example of the effects of irregular work schedules on sleep. In: Colquhoun WP, ed. Aspects of Human Efficiency. Diurnal Rhythm and Loss of Sleep. London: The English Universities Press Ltd; 1972:273-281.Google Scholar
  23. 23.
    Åkerstedt T, Gillberg M. The circadian variation of experimentally displaced sleep. Sleep. 1981;4:159-169.PubMedGoogle Scholar
  24. 24.
    Czeisler CA, Weitzman ED, Moore-Ede MC, Zimmerman JC, Knauer RS. Human sleep: its duration and organization depend on its circadian phase. Science. 1980;210:1264-1267.PubMedCrossRefGoogle Scholar
  25. 25.
    Åkerstedt T, Gillberg M. A dose-response study of sleep loss and spontaneous sleep termination. Psychophysiology. 1986;23:293-297.PubMedCrossRefGoogle Scholar
  26. 26.
    McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Horm Behav. 2003;43(1):2-15.PubMedCrossRefGoogle Scholar
  27. 27.
    McEwen BS. Protection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Ann N Y Acad Sci. 2004;1032:1-7.PubMedCrossRefGoogle Scholar
  28. 28.
    Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation survey. I. Sleep. 1999;22 Suppl.2:S347-S353.PubMedGoogle Scholar
  29. 29.
    Morphy H, Dunn M, Lewis M, Boardman HF, Croft PR. Epidemiology of insomnia: a ­longitudinal study in a UK population. Sleep. 2007;30(3):274-280.PubMedGoogle Scholar
  30. 30.
    Ribet C, Derriennic F. Age, working conditions, and sleep disorders: a longitudinal analysis in the French Cohort E.S.T.E.V. Sleep. 1999;22:491-504.PubMedGoogle Scholar
  31. 31.
    Urponen H, Vuori I, Hasan J, Partinen M. Self-evaluations of factors promoting and disturbing sleep: an epidemiological survey in Finland. Soc Sci Med. 1988;26:443-450.PubMedCrossRefGoogle Scholar
  32. 32.
    Åkerstedt T, Fredlund P, Gillberg M, Jansson B. Work load and work hours in relation to disturbed sleep and fatigue in a large representative sample. J Psychosom Res. 2002;53:585-588.PubMedCrossRefGoogle Scholar
  33. 33.
    Morin CM, Rodrigue S, Ivers H. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med. 2003;65:259-267.PubMedCrossRefGoogle Scholar
  34. 34.
    Cernovsky ZZ. Life stress measures and reported frequency of sleep disorders. Percept Mot Skills. 1984;58:39-49.PubMedCrossRefGoogle Scholar
  35. 35.
    Jansson M, Linton SJ. Psychosocial work stressors in the development and maintenance of insomnia: a prospective study. J Occup Health Psychol. 2006;11(3):241-248.PubMedCrossRefGoogle Scholar
  36. 36.
    Holdstock TL, Verschoor GJ. Student sleep patterns before, during and after an examination period. J Psychol. 1974;4:16-24.Google Scholar
  37. 37.
    Åkerstedt T. Sleep and stress. In: Peter JH, Podszus T, von Wichert P, eds. Sleep Related Disorders and Internal Diseases. Heidelberg: Springer; 1987:183-191.CrossRefGoogle Scholar
  38. 38.
    Drake C, Richardson G, Roehrs T, Scofield H, Roth T. Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep. 2004;27:285-291.PubMedGoogle Scholar
  39. 39.
    Partinen M, Eskelinen L, Tuomi K. Complaints of insomnia in different occupations. Scand J Work Environ Health. 1984;10:467-469.PubMedCrossRefGoogle Scholar
  40. 40.
    Geroldi C, Frisoni GB, Rozzini R, De Leo D, Trabucchi M. Principal lifetime occupation and sleep quality in the elderly. Gerontology. 1996;42:163-169.PubMedCrossRefGoogle Scholar
  41. 41.
    Kuppermann M, Lubeck DP, Mazonson PD, et al. Sleep problems and their correlates in a working population. J Gen Intern Med. 1995;10:25-32.PubMedCrossRefGoogle Scholar
  42. 42.
    Bixler EO, Kales A, Soldatos CR. Sleep disorders encountered in medical practice: a national survey of physicians. Behav Med. 1979;3:1-6.Google Scholar
  43. 43.
    Åkerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G. Sleep ­disturbances, work stress and work hours. A cross-sectional study. J Psychosom Res. 2002;53:741-748.PubMedCrossRefGoogle Scholar
  44. 44.
    Harvey AG, Tang NK, Browning L. Cognitive approaches to insomnia. Clin Psychol Rev. 2005;25(5):593-611.PubMedCrossRefGoogle Scholar
  45. 45.
    Hall M, Buysse DJ, Nowell PD, et al. Symptoms of stress and depression as correlates of sleep in primary Insomnia. Psychosom Med. 2000;62:227-230.PubMedGoogle Scholar
  46. 46.
    Haynes SN, Adams A, Franzen M. The effects of presleep stress on sleep-onset insomnia. J Abnorm Psychol. 1981;90:601-606.PubMedCrossRefGoogle Scholar
  47. 47.
    Tang NKY, Harvey AG. Effects of cognitive arousal and physiological arousal on sleep ­perception. Sleep. 2004;27:69-78.PubMedGoogle Scholar
  48. 48.
    Kecklund G, Åkerstedt T. Objective components of individual differences in subjective sleep quality. J Sleep Res. 1997;6:217-220.CrossRefGoogle Scholar
  49. 49.
    Kecklund G, Åkerstedt T, Lowden A. Morning work: effects of early rising on sleep and ­alertness. Sleep. 1997;20(3):215-223.PubMedGoogle Scholar
  50. 50.
    Akerstedt T, Kecklund G, Axelsson J. Impaired sleep after bedtime stress and worries. Biol Psychol. 2007;76(3):170-173.PubMedCrossRefGoogle Scholar
  51. 51.
    Askenasy JJM, Lewin I. The impact of missile warfare on self-reported sleep quality. Part 1. Sleep. 1996;19:47-51.PubMedGoogle Scholar
  52. 52.
    Davidson L, Fleming R, Baum A. Chronic stress, catecholamines, and sleep disturbance at three Mile Island. J Human Stress. 1987;13:75-83.PubMedCrossRefGoogle Scholar
  53. 53.
    Reynolds CF III, Hoch CC, Buysse DJ, et al. Sleep after spousal bereavement: a study of recovery from stress. Biol Psychiatry. 1993;34:791-797.PubMedCrossRefGoogle Scholar
  54. 54.
    Nordin M, Knutsson A, Sundbom E. Is disturbed sleep a mediator in the association between social support and myocardial infarction? J Health Psychol. 2008;13(1):55-64.PubMedCrossRefGoogle Scholar
  55. 55.
    Fabsitz RR, Sholinsky P, Goldberg J. Correlates of sleep problems among men: the Vietnam era twin registry. J Sleep Res. 1997;6:50-60.PubMedCrossRefGoogle Scholar
  56. 56.
    Dow BM, Kelsoe JR, Gillin JC. Sleep and dreams in Vietnam PTSD and depression. Biol Psychiatry. 1996;39:42-50.PubMedCrossRefGoogle Scholar
  57. 57.
    Mellman TA, Nolan B, Hebding J, Kulick-Bell R, Dominguez R. A polysomnographic comparison of veterans with combat-related PTSD, depressed men, and non-ill controls. Sleep. 1997;20:46-51.PubMedGoogle Scholar
  58. 58.
    Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep – what a nightmare! Sleep Med Rev. 2000;4:183-200.PubMedCrossRefGoogle Scholar
  59. 59.
    Ross RJ, Ball WA, Dinges DF, et al. Motor dysfunction during sleep in posttraumatic stress disorder. Sleep. 1994;17:723-732.PubMedGoogle Scholar
  60. 60.
    AASM. ICSD – International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Chicago: American Academy of Sleep Medicine; 2005.Google Scholar
  61. 61.
    APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM-IV). Washington DC: American Psychiatric Association; 1994.Google Scholar
  62. 62.
    Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW. Quantitative criteria for ­insomnia. Behav Res Ther. 2003;41(4):427-445.PubMedCrossRefGoogle Scholar
  63. 63.
    Ohayon M, Caulet M, Priest R, Guilleminault C. DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction. Br J Psychiatry. 1997;171:382-388.PubMedCrossRefGoogle Scholar
  64. 64.
    Jansson-Frojmark M, Linton SJ. The course of insomnia over one year: a longitudinal study in the general population in Sweden. Sleep. 2008;31(6):881-886.PubMedGoogle Scholar
  65. 65.
    Roth T, Drake C. Evolution of insomnia: current status and future direction. Sleep Med. 2004;5(suppl 1):S23-S30.PubMedCrossRefGoogle Scholar
  66. 66.
    Ohayon MM, Guilleminault C, Paiva T, et al. An international study on sleep disorders in the general population: methosological aspects of the use of the sleep-EVAL system. Sleep. 1997;20:1086-1092.PubMedGoogle Scholar
  67. 67.
    Sateia M, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. Sleep. 2000;23:243-263.PubMedGoogle Scholar
  68. 68.
    Adam K, Tomeny M, Oswald I. Physiological and psychological differences between good and poor sleepers. J Psychiatr Res. 1986;20(4):301-316.PubMedCrossRefGoogle Scholar
  69. 69.
    Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med. 1998;60:610-615.PubMedGoogle Scholar
  70. 70.
    Monroe L. Psychological and physiological differences between good and poor sleepers. J Abnorm Psychol. 1967;72:255-264.PubMedCrossRefGoogle Scholar
  71. 71.
    Perlis ML, Merica H, Smith MT, Giles DE. Beta EEG activity and insomnia. Sleep Med Rev. 2001;5(5):365-376.CrossRefGoogle Scholar
  72. 72.
    Bonnet MH, Arand DL. Insomnia, metabolic rate and sleep restoration. J Intern Med. 2003;254(1):23-31.PubMedCrossRefGoogle Scholar
  73. 73.
    Wong KK, Marshall NS, Grunstein RR, Dodd MJ, Rogers NL. Comparing the neurocognitive effects of 40 h sustained wakefulness in patients with untreated OSA and healthy controls. J Sleep Res. 2008;17:322-330.PubMedCrossRefGoogle Scholar
  74. 74.
    Terán-Santos J, Jimnénez-Gómez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. N Engl J Med. 1999;24:847-851.CrossRefGoogle Scholar
  75. 75.
    Lopez-Jimenez F, Somers VK. Stress measures linking sleep apnea, hypertension and ­diabetes–AHI vs arousals vs hypoxemia. Sleep. 2006;29(6):743-744.PubMedGoogle Scholar
  76. 76.
    Lavie L. Sleep apnea syndrome, endothelial dysfunction, and cardiovascular morbidity. Sleep. 2004;27:1053-1055.PubMedGoogle Scholar
  77. 77.
    Mulgrew AT, Ryan CF, Fleetham JA, et al. The impact of obstructive sleep apnea and daytime sleepiness on work limitation. Sleep Med. 2007;9(1):42-53.PubMedCrossRefGoogle Scholar
  78. 78.
    Zee PC, Manthena P. The brain’s master circadian clock: implications and opportunities for therapy of sleep disorders. Sleep Med Rev. 2007;11(1):59-70.PubMedCrossRefGoogle Scholar
  79. 79.
    Wolk R, Gami AS, Garcia-Touchard A, Somers VK. Sleep and cardiovascular disease. Curr Probl Cardiol. 2005;30(12):625-662.PubMedCrossRefGoogle Scholar
  80. 80.
    Otto ME, Svatikova A, Barretto RB, et al. Early morning attenuation of endothelial function in healthy humans. Circulation. 2004;109(21):2507-2510.PubMedCrossRefGoogle Scholar
  81. 81.
    Tofler GH, Brezinski D, Schafer AI, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987;316(24):1514-1518.PubMedCrossRefGoogle Scholar
  82. 82.
    Muller JE, Stone PH, Zoltan GT, et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med. 1985;313:1315-1322.PubMedCrossRefGoogle Scholar
  83. 83.
    Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human cardiovascular health and disease. Mayo Clin Proc. 2009;84(9):822-830.PubMedCrossRefGoogle Scholar
  84. 84.
    Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009;51(4):294-302.PubMedCrossRefGoogle Scholar
  85. 85.
    Gottlieb DJ, Redline S, Nieto FJ, et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006;29(8):1009-1014.PubMedGoogle Scholar
  86. 86.
    Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009;32(4):491-497.PubMedGoogle Scholar
  87. 87.
    Steiger A. Sleep and the hypothalamo-pituitary-adrenocortical system. Sleep Med Rev. 2002;6(2):125-138.PubMedCrossRefGoogle Scholar
  88. 88.
    Steiger A, Antonijevic IA, Bohlhalter S, Frieboes RM, Friess E, Murck H. Effects of hormones on sleep. Horm Res. 1998;49:125-130.PubMedCrossRefGoogle Scholar
  89. 89.
    Ekstedt M, Åkerstedt T, Söderström M. Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure. Psychosom Med. 2004;66:925-931.PubMedCrossRefGoogle Scholar
  90. 90.
    Van Cauter E, Latta F, Nedeltcheva A, et al. Reciprocal interactions between the GH axis and sleep. Growth Horm IGF Res. 2004;14:S10-S17.PubMedCrossRefGoogle Scholar
  91. 91.
    Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11(3):163-178.PubMedCrossRefGoogle Scholar
  92. 92.
    Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008;31(5):635-643.PubMedGoogle Scholar
  93. 93.
    Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008;16(3):643-653.CrossRefGoogle Scholar
  94. 94.
    Tasali E, Leproult R, Spiegel K. Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis. 2009;51(5):381-391.PubMedCrossRefGoogle Scholar
  95. 95.
    Nilsson P, Rööst M, Engström G, Hedblad B, Janzon L, Berglund G. Incidence of diabetes in middle-aged men is related to resting heart rate and difficulties to fall asleep. (Abstract). Paper presented at: the 7th International Congress of Behavioural Medicine; 2002; Helsinki.Google Scholar
  96. 96.
    Nilsson PM, Rööst M, Engström G, Hedblad B, Berglund G. Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care. 2004;27:2464-2469.PubMedCrossRefGoogle Scholar
  97. 97.
    Bryant PA, Trinder J, Curtis N. Sick and tired: does sleep have a vital role in the immune ­system. Nat Rev Immunol. 2004;4:457-467.PubMedCrossRefGoogle Scholar
  98. 98.
    Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K, Chrousos GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab. 1997;82(5):1313-1316.PubMedCrossRefGoogle Scholar
  99. 99.
    Nilsson P, Nilsson J-Å, Hedblad B, Berglund G. Sleep disturbances in association with elevated pulse rate for the prediction of mortality – consequences of mental strain? J Intern Med. 2001;250:521-529.PubMedCrossRefGoogle Scholar
  100. 100.
    Leineweber C, Kecklund G, Janszky I, Åkerstedt T, Orth-Gomér K. Poor sleep increases the prospective risk for recurrent events in middle-aged women with coronary disease. The Stockholm Female Coronary Risk Study. J Psychosom Res. 2003;54:121-127.PubMedCrossRefGoogle Scholar
  101. 101.
    Appels A, Schouten E. Waking up exhausted as risk indicator of myocardial infarction. Am J Cardiol. 1991;68:395-398.PubMedCrossRefGoogle Scholar
  102. 102.
    van Diest R, Appels AWPM. Sleep physiological characteristics of exhausted men. Psychosom Med. 1994;56:28-35.PubMedGoogle Scholar
  103. 103.
    Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull. 2006;132(3):327-353.PubMedCrossRefGoogle Scholar
  104. 104.
    Kripke DF, Simons RN, Garfinkel L, Hammond EC. Short and long sleep and sleeping pills. Arch Gen Psychiatry. 1979;36:103-116.PubMedCrossRefGoogle Scholar
  105. 105.
    Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131-136.PubMedCrossRefGoogle Scholar
  106. 106.
    Ferrie JE, Shipley MJ, Cappuccio FP, et al. A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep. 2007;30(12):1659-1666.PubMedGoogle Scholar
  107. 107.
    Hublin C, Partinen M, Koskenvuo M, Kaprio J. Sleep and mortality: a population-based 22-year follow-up study. Sleep. 2007;30(10):1245-1253.PubMedGoogle Scholar
  108. 108.
    Amagai Y, Ishikawa S, Gotoh T, et al. Sleep duration and mortality in Japan: the Jichi Medical School Cohort Study. J Epidemiol. 2004;14(4):124-128.PubMedCrossRefGoogle Scholar
  109. 109.
    Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163(2):205-209.PubMedCrossRefGoogle Scholar
  110. 110.
    Empana JP, Dauvilliers Y, Dartigues JF, et al. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke. 2009;40(4):1219-1224.PubMedCrossRefGoogle Scholar
  111. 111.
    Patel SR, Ayas NT, Malhotra MR, et al. A prospective study of sleep duration and mortality risk. Sleep. 2004;27:440-444.PubMedGoogle Scholar
  112. 112.
    Heslop P, Smith GD, Metcalfe C, Macleod J, Hart C. Sleep duration and mortality: the effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med. 2002;3(4):305-314.PubMedCrossRefGoogle Scholar
  113. 113.
    Meisinger C, Heier M, Lowel H, Schneider A, Doring A. Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general ­population: the MONICA/KORA Augsburg cohort study. Sleep. 2007;30(9):1121-1127.PubMedGoogle Scholar
  114. 114.
    Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251(3):207-216.PubMedCrossRefGoogle Scholar
  115. 115.
    Ekstedt M, Söderström M, Åkerstedt T, Nilsson J, Sondergaard H-P, Perski A. Disturbed sleep and fatigue in occupational burnout. Scand J Work Environ Health. 2006;32(2):121-131.PubMedCrossRefGoogle Scholar
  116. 116.
    Gopalakrishnan P, Ragland MM, Tak T. Gender differences in coronary artery disease: review of diagnostic challenges and current treatment. Postgrad Med. 2009;121(2):60-68.PubMedCrossRefGoogle Scholar
  117. 117.
    Wenger NK. Preventing cardiovascular disease in women: an update. Clin Cardiol. 2008;31(3):109-113.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Stress Research InstituteStockholm UniversityStockholmSweden

Personalised recommendations