Doctors who sleep less have a 97% chance to make mistakes

Some basic lifestyle habits improve our health. However, we fail to adhere to some of these basic nature prescriptions, and this eventually predisposes us to most of the modern health crises.

Studies have confirmed the many benefits of sleep on our health.

It has also been established we need about 7 and 9 hours of sleep per night. However, due to current situations, most fail to get enough sleep.  

The interesting thing is that though sleep is good for our health, studies have also confirmed that if you sleep too much it could also predispose you to cardiovascular diseases. Is this not interesting?

I also found that sleep is akin to eating nutritious food, drinking water, and exercising regularly, getting quality sleep is an important component of overall health. Although the exact reasons humans need to sleep remain unknown, sleep experts agree there are numerous benefits to consistently getting a full night’s rest.

While sleeping, the body performs several repairing and maintaining processes that affect nearly every part of the body. As a result, a good night’s sleep, or a lack of sleep, can impact the body both mentally and physically. In this article, I review the benefits and side effects of too much sleep.

Sleep, supporting literature

Weight

Some studies (Brum et al. 2020; Itani et al. 2017; Cooper et al. 2018) confirmed that when we sleep less than 7 hours per night; we have an increased risk of weight gain and a higher body mass index (BMI).

Another study (Bacaro et al. 2020) also found that adults who slept less than 7 hours per night had a 41% increased risk of developing obesity. On the other hand, when we sleep longer, we experienced no increased risk.  

In the case of Cooper et al. (2018), the study held that many factors account for the sleep effect on weight gain, such as hormones and motivation to exercise.

Another study (Ding et al. 2018) found that when we deprived ourselves of sleep, there are increased levels of ghrelin and decreased levels of leptin.  These two hormones control our drives to eat: Ghrelin makes us feel hungry and leptin makes us feel full. This may cause us to feel hungrier and overeat.

For instance, two studies (Dashti et al. 2015; Satterfield and Killgore, 2020) found that those who deprived themselves of sleep eat more calories due to a higher appetite drive.

And the danger is that to compensate for the lack of energy, when you deprived yourself of sleep it makes you crave foods that are higher in sugar and fat, due to their higher calorie content (Yang et al. 2019; Khatib et al. 2017).

Sleep improves concentration & Productivity

Studies have established the benefits of sleep on brain function. For instance, (Hudson et al. 2020; Eugene and Masiak, 2015; Krause et al. 2017) studies attest that when we deprived ourselves of sleep, our cognition, concentration, productivity, and performance are all negatively affected.

This was demonstrated in an important study (Trockel et al. 2020) where doctors with moderate, high, and very high sleep-related impairment were 54%, 96%, and 97% more likely to report clinically significant medical errors. This means that medical people need good sleep to save patients.

Apart from that, other studies (Okano et al. 2019; Zeek et al. 2015; Turner et al. 2021; Stormark et al. 2019) found that when we sleep well, we improve our academic performance- children, adolescents, and young adults.

Finally,  (Dai et al. 2020; Könen et al. 2015; Rana et al. 2018) also note that when we have good sleep, helps to improve our problem-solving skills and enhance memory performance in both children and adults.

Increases athletic performance

Studies have also confirmed the impact of sleep on athletic performance. For instance, (Vitale et al. 2019; Charest and Grandner, 2020; Bonnar et al. 2018) found that adequate sleep can enhance fine motor skills, reaction time, muscular power, muscular endurance, and problem-solving skills.

In the case of Charest and Grandner (2020), the authors held that lack of sleep could increase our risk of injury and decrease our interest to exercise.

Cardio support

Some studies, (Covassin and Singh, 2016; Javaheri and Redline, 2017; Drager et al. 2017) established that low sleep quality and duration could increase our risk of developing heart disease.  In the case of Krittanawong et al.(2017), 19 reviews found that sleeping less than 7 hours per day resulted in a 13% increased risk of death from heart disease.

Another analysis by Yin et al. (2017)found that compared with 7 hours of sleep, each 1-hour decrease in sleep was associated with a 6% increased risk of all-cause mortality and heart disease.

Additionally, (Makarem et al. 2021; Makarem et al. 2019) also found that when we engage in short sleep, it tends to increase the risk of high blood pressure, especially in those with obstructive sleep apnea — a condition characterized by interrupted breathing during sleep.

For instance, Wang et al. (2015) found that people who slept less than 5 hours per night had a 61% higher risk of developing high blood pressure than those who slept 7 hours.

When one would think that it is better to sleep more;  It appears otherwise, and three studies(Krittanawong et al. 2019; Yin et al. 2017; Wang et al. 2015) found that excessive sleep in adults — more than 9 hours —is linked to increased risk of heart disease and high blood pressure.

Diabetes risk

Chattu et al.(2014) established that short sleep is linked to a higher risk of getting type 2 diabetes and insulin resistance — meaning your body cannot use the hormone insulin appropriately.

In another study, Anothaisintawee et al.(2016) examined 36 studies with over 1 million participants and found that when we sleep  5 hours or  6 hours increased the risk of developing type 2 diabetes by 48% and 18%, respectively.

Additionally, Grandner et al. (2016) believed that when we don’t sleep can cause physiological changes like decreased insulin sensitivity, increased inflammation, and hunger hormone changes, as well as behavioural changes like poor decision-making and greater food intake — all of which increase diabetes risk.

Finally, (Grandner et al. 2016; Kim et al. 2018) established that when we also don’t sleep, it can lead to a higher risk of developing obesity, heart disease, and metabolic syndrome, and, in turn, can increase the risk of diabetes

Poor sleep is linked to depression

Some studies (Li et al. 2016; Marino et al. 2021; Oh et al. 2019) have linked mental health conditions, such as depression, to poor sleep quality and sleeping disorders.

For instance, Oh et al. (2019) study of 2,672 participants found that those with anxiety and depression were more likely to report poorer sleep scores than those without anxiety and depression.

In other studies, (Hayley et al. 2015; Fang et al. 2019) found that people with sleeping disorders such as insomnia or obstructive sleep apnea also report higher rates of depression than those without. This is therefore prudent for those with sleeping challenges and mental health issues to seek medical help.

 Immunity enhancement

Some studies (Besedovsky et al. 2019; Opp and Krueger, 2015) have associated lack of sleep to impair immune function.

In one study, Prather et al.(2015) found that respondents who slept less than 5 hours per night were 4.5 times more likely to develop a cold as compared to those who slept more than 7 hours.

Additionally, in a recent study by Prather et al. (2021), the authors found that those who sleep well improve their body’s antibody responses to influenza vaccines.  This means good sleep before and after affects vaccination.

This was further confirmed in recent studies by (Benedict and Cedernaes, 2021; Robertson and Goldin, 2022; Zhu et al. 2021; Kow and Hasan, 2021), the authors found that having good sleep before and after receiving a COVID-19 vaccination may improve vaccine efficacy.

Poor sleep and inflammation

Studies have established that not having a good sleep can have a major effect on inflammation in the body. For instance, Irwin, MR(2019) found that sleep plays an important role in the regulation of our central nervous system.  The author further asserts that it is also involved in the stress-response systems known as the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis.

Subsequent studies (Irwin et al. 2016; Irwin, 2019) also linked Sleep loss, from not sleeping, activate inflammatory signaling pathways and lead to higher levels of undesirable markers of inflammation, like interleukin-6 and C-reactive protein.

They further explained that when this happens for a longer period, chronic inflammation can trigger many chronic conditions, including obesity, heart disease, certain types of cancer, Alzheimer’s disease, depression, and type 2 diabetes.

Emotions and social interactions

Studies have also established that sleep loss reduces our ability to regulate emotions and interact socially. For instance, two studies(Dorrian et al. 2019; Beattie et al. 2015) held that we find it difficult to control our emotions when we become frustrated leading to outbursts. Thus tiredness could also affect our ability to respond to humor and show empathy.

Thus, Simon and Walker’s (2018) study found that people who are frequently sleep-deprived are more likely to withdraw from social events and experience loneliness.  Hence, there is a need to pay attention to sleep to enhance our relationships with others and help us become more social.

Lack of sleep can be dangerous

It has been established that if we don’t have good sleep can be dangerous. For instance, being severely sleep-deprived is comparable to having consumed excess alcohol. Joe Leech(2022) in his article on sleep reports that the Centers for Disease Control and Prevention (CDC) found that 1 in 25 people have fallen asleep at the wheel while driving. Those who slept fewer than 6 hours were most likely to fall asleep while driving.

This was further complemented in one study(Tefft BC, 2018) that found that people who slept 6, 5, 4, or fewer than 4 hours had a risk of causing a car accident that was 1.3, 1.9, 2.9, and 15.1 times higher, respectively. This study suggests that your risk of a car accident increases significantly with each hour of lost sleep.

Additionally,  the CDC found that if we don’t sleep for more than 18 hours is similar to having a blood alcohol content (BAC) of 0.05%. After 24 hours, this increases to 1.00%, which is over the legal driving limit.

In a previous study, Hassani et al.(2015) found that lack of sleep may also increase the risk of workplace injury and errors.  In a nutshell, having enough sleep is helpful for our safety.

Take Home

I have found that sleep is akin to paying attention to your diet and exercise. Hence, as you pay attention to a good diet, if you neglect sound sleep, you have done nothing. I have also found that our needs in sleeping differ. However, for sound sleep, studies recommend that you should get between 7 and 9 hours of sleep per night for optimal health.  Failure to do this could predispose you to the many negative health implications associated: with heart disease, depression, weight gain, inflammation, and sickness.

The most interesting thing I also found is that if you sleep more than 9 hours too you are predisposing yourself to too many negative health issues. So don’t sleep less and don’t go overboard for 9 hours. This means latest by 10 pm one should go to bed. Those with a different work schedule should have a sleep pattern to meet their health needs.  

NB:

Prof. Nyarkotey has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations to justify his write-ups.  My articles are for educational purposes and do not serve as Medical advice for Treatment. I aim to educate the public about evidence-based scientific Naturopathic Therapies.

The writer is a Professor of Naturopathic Healthcare, President, of Nyarkotey College of Holistic Medicine & Technology (NUCHMT)/African Naturopathic Foundation.

References

1. Dorrian J, Centofanti S, Smith A, McDermott KD. Self-regulation and social behavior during sleep deprivation. Prog Brain Res. 2019;246:73-110. doi: 10.1016/bs.pbr.2019.03.010. Epub 2019 Apr 10. PMID: 31072564.
2. Beattie L, Kyle SD, Espie CA, Biello SM. Social interactions, emotion and sleep: A systematic review and research agenda. Sleep Med Rev. 2015 Dec;24:83-100. doi: 10.1016/j.smrv.2014.12.005. Epub 2014 Dec 27. PMID: 25697832.
3. Ben Simon E, Walker MP. Sleep loss causes social withdrawal and loneliness. Nat Commun. 2018 Aug 14;9(1):3146. doi: 10.1038/s41467-018-05377-0. PMID: 30108218; PMCID: PMC6092357.
4. Tefft BC. Acute sleep deprivation and culpable motor vehicle crash involvement. Sleep. 2018 Oct 1;41(10). doi: 10.1093/sleep/zsy144. PMID: 30239905.
5. Hassani S, Rahnama N, Seyedmehdi SM, Yazdanparast T, Roozbahani R, Attarchi M, Adimi Naghan P, Jamaati H. Association between Occupational Accidents and Sleep Apnea in Hospital Staff. Tanaffos. 2015;14(3):201-7. PMID: 26858766; PMCID: PMC4745189.
6. Li L, Wu C, Gan Y, Qu X, Lu Z. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2016 Nov 5;16(1):375. doi: 10.1186/s12888-016-1075-3. PMID: 27816065; PMCID: PMC5097837.
7. Marino C, Andrade B, Campisi SC, Wong M, Zhao H, Jing X, Aitken M, Bonato S, Haltigan J, Wang W, Szatmari P. Association Between Disturbed Sleep and Depression in Children and Youths: A Systematic Review and Meta-analysis of Cohort Studies. JAMA Netw Open. 2021 Mar 1;4(3):e212373. doi: 10.1001/jamanetworkopen.2021.2373. PMID: 33749768; PMCID: PMC7985724.
8. Oh CM, Kim HY, Na HK, Cho KH, Chu MK. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Front Neurol. 2019 Aug 13;10:849. doi: 10.3389/fneur.2019.00849. PMID: 31456736; PMCID: PMC6700255.
9. Hayley AC, Williams LJ, Venugopal K, Kennedy GA, Berk M, Pasco JA. The relationships between insomnia, sleep apnoea and depression: findings from the American National Health and Nutrition Examination Survey, 2005-2008. Aust N Z J Psychiatry. 2015 Feb;49(2):156-70. doi: 10.1177/0004867414546700. Epub 2014 Aug 15. PMID: 25128225.
10. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019 Apr;23(4):2324-2332. doi: 10.1111/jcmm.14170. Epub 2019 Feb 7. PMID: 30734486; PMCID: PMC6433686.
11. Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019 Jul 1;99(3):1325-1380. doi: 10.1152/physrev.00010.2018. PMID: 30920354; PMCID: PMC6689741.
12. Opp MR, Krueger JM. Sleep and immunity: A growing field with clinical impact. Brain Behav Immun. 2015 Jul;47:1-3. doi: 10.1016/j.bbi.2015.03.011. Epub 2015 Apr 4. PMID: 25849976; PMCID: PMC4685944
13. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015 Sep 1;38(9):1353-9. doi: 10.5665/sleep.4968. PMID: 26118561; PMCID: PMC4531403.
14. Prather AA, Pressman SD, Miller GE, Cohen S. Temporal Links Between Self-Reported Sleep and Antibody Responses to the Influenza Vaccine. Int J Behav Med. 2021 Feb;28(1):151-158. doi: 10.1007/s12529-020-09879-4. PMID: 32236831.
15. Benedict C, Cedernaes J. Could a good night’s sleep improve COVID-19 vaccine efficacy? Lancet Respir Med. 2021 May;9(5):447-448. doi: 10.1016/S2213-2600(21)00126-0. Epub 2021 Mar 12. PMID: 33721558; PMCID: PMC7954467.
16. Robertson R, Goldin J. Potential immune-boosting power of sleep to improve COVID-19 vaccine efficacy. Intern Med J. 2022 Jan;52(1):158-159. doi: 10.1111/imj.15629. PMID: 34878216.
17. Zhu J, Zhang M, Sanford LD, Tang X. Advice for COVID-19 vaccination: get some sleep. Sleep Breath. 2021 Dec;25(4):2287-2288. doi: 10.1007/s11325-021-02313-3. Epub 2021 Feb 17. PMID: 33598782; PMCID: PMC7889055.
18. Kow CS, Hasan SS. Do sleep quality and sleep duration before or after COVID-19 vaccination affect antibody response? Chronobiol Int. 2021 Jul;38(7):941-943. doi: 10.1080/07420528.2021.1900216. Epub 2021 Mar 26. PMID: 33771061.
19. Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol. 2019 Nov;19(11):702-715. doi: 10.1038/s41577-019-0190-z. PMID: 31289370.
20. Irwin MR, Olmstead R, Carroll JE. Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biol Psychiatry. 2016 Jul 1;80(1):40-52. doi: 10.1016/j.biopsych.2015.05.014. Epub 2015 Jun 1. PMID: 26140821; PMCID: PMC4666828.
21. Brum MCB, Dantas Filho FF, Schnorr CC, Bertoletti OA, Bottega GB, da Costa Rodrigues T. Night shift work, short sleep and obesity. Diabetol Metab Syndr. 2020 Feb 10;12:13. doi: 10.1186/s13098-020-0524-9. PMID: 32064002; PMCID: PMC7011518.
22. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017 Apr;32:246-256. doi: 10.1016/j.sleep.2016.08.006. Epub 2016 Aug 26. PMID: 27743803.
23. Cooper CB, Neufeld EV, Dolezal BA, Martin JL. Sleep deprivation and obesity in adults: a brief narrative review. BMJ Open Sport Exerc Med. 2018 Oct 4;4(1):e000392. doi: 10.1136/bmjsem-2018-000392. PMID: 30364557; PMCID: PMC6196958.
24. Bacaro V, Ballesio A, Cerolini S, Vacca M, Poggiogalle E, Donini LM, Lucidi F, Lombardo C. Sleep duration and obesity in adulthood: An updated systematic review and meta-analysis. Obes Res Clin Pract. 2020 Jul-Aug;14(4):301-309. doi: 10.1016/j.orcp.2020.03.004. Epub 2020 Jun 8. PMID: 32527625.
25. Ding C, Lim LL, Xu L, Kong APS. Sleep and Obesity. J Obes Metab Syndr. 2018 Mar 30;27(1):4-24. doi: 10.7570/jomes.2018.27.1.4. PMID: 31089536; PMCID: PMC6489488
26. Dashti HS, Scheer FA, Jacques PF, Lamon-Fava S, Ordovás JM. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv Nutr. 2015 Nov 13;6(6):648-59. doi: 10.3945/an.115.008623. PMID: 26567190; PMCID: PMC4642416.
27. Satterfield BC, Killgore WDS. Habitual sleep duration predicts caloric and macronutrient intake during sleep deprivation. Sleep Health. 2020 Feb;6(1):88-91. doi: 10.1016/j.sleh.2019.08.012. Epub 2019 Oct 31. PMID: 31680050.
28. Yang CL, Schnepp J, Tucker RM. Increased Hunger, Food Cravings, Food Reward, and Portion Size Selection after Sleep Curtailment in Women Without Obesity. Nutrients. 2019 Mar 19;11(3):663. doi: 10.3390/nu11030663. PMID: 30893841; PMCID: PMC6470707.
29. Al Khatib HK, Harding SV, Darzi J, Pot GK. The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr. 2017 May;71(5):614-624. doi: 10.1038/ejcn.2016.201. Epub 2016 Nov 2. PMID: 27804960.
30. Hudson AN, Van Dongen HPA, Honn KA. Sleep deprivation, vigilant attention, and brain function: a review. Neuropsychopharmacology. 2020 Jan;45(1):21-30. doi: 10.1038/s41386-019-0432-6. Epub 2019 Jun 8. PMID: 31176308; PMCID: PMC6879580.
31. Eugene AR, Masiak J. The Neuroprotective Aspects of Sleep. MEDtube Sci. 2015 Mar;3(1):35-40. PMID: 26594659; PMCID: PMC4651462.
32. Krause AJ, Simon EB, Mander BA, Greer SM, Saletin JM, Goldstein-Piekarski AN, Walker MP. The sleep-deprived human brain. Nat Rev Neurosci. 2017 Jul;18(7):404-418. doi: 10.1038/nrn.2017.55. Epub 2017 May 18. PMID: 28515433; PMCID: PMC6143346.
33. Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, Kim PK, Quinn MA, Lawrence E, Marchalik D, Farley H, Normand P, Felder M, Dudley JC, Shanafelt TD. Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors. JAMA Netw Open. 2020 Dec 1;3(12):e2028111. doi: 10.1001/jamanetworkopen.2020.28111. PMID: 33284339.
34. Okano K, Kaczmarzyk JR, Dave N, Gabrieli JDE, Grossman JC. Sleep quality, duration, and consistency are associated with better academic performance in college students. NPJ Sci Learn. 2019 Oct 1;4:16. doi: 10.1038/s41539-019-0055-z. PMID: 31583118; PMCID: PMC6773696.
35. Zeek ML, Savoie MJ, Song M, Kennemur LM, Qian J, Jungnickel PW, Westrick SC. Sleep Duration and Academic Performance Among Student Pharmacists. Am J Pharm Educ. 2015 Jun 25;79(5):63. doi: 10.5688/ajpe79563. PMID: 26396272; PMCID: PMC4571043.
36. Turner RW 2nd, Vissa K, Hall C, Poling K, Athey A, Alfonso-Miller P, Gehrels JA, Grandner MA. Sleep problems are associated with academic performance in a national sample of collegiate athletes. J Am Coll Health. 2021 Jan;69(1):74-81. doi: 10.1080/07448481.2019.1655027. Epub 2019 Sep 9. PMID: 31498755; PMCID: PMC7061068
37. Stormark KM, Fosse HE, Pallesen S, Hysing M. The association between sleep problems and academic performance in primary school-aged children: Findings from a Norwegian longitudinal population-based study. PLoS One. 2019 Nov 7;14(11):e0224139. doi: 10.1371/journal.pone.0224139. PMID: 31697711; PMCID: PMC6837329.
38. Dai C, Zhang Y, Cai X, Peng Z, Zhang L, Shao Y, Wang C. Effects of Sleep Deprivation on Working Memory: Change in Functional Connectivity Between the Dorsal Attention, Default Mode, and Fronto-Parietal Networks. Front Hum Neurosci. 2020 Oct 12;14:360. doi: 10.3389/fnhum.2020.00360. PMID: 33192381; PMCID: PMC7588803.
39. Könen T, Dirk J, Schmiedek F. Cognitive benefits of last night’s sleep: daily variations in children’s sleep behavior are related to working memory fluctuations. J Child Psychol Psychiatry. 2015 Feb;56(2):171-82. doi: 10.1111/jcpp.12296. Epub 2014 Jul 23. PMID: 25052368.
40. Rana BK, Panizzon MS, Franz CE, Spoon KM, Jacobson KC, Xian H, Ancoli-Israel S, Lyons M, Kremen WS. Association of Sleep Quality on Memory-Related Executive Functions in Middle Age. J Int Neuropsychol Soc. 2018 Jan;24(1):67-76. doi: 10.1017/S1355617717000637. Epub 2017 Aug 1. PMID: 28760172; PMCID: PMC5958545
41. Vitale KC, Owens R, Hopkins SR, Malhotra A. Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. Int J Sports Med. 2019 Aug;40(8):535-543. doi: 10.1055/a-0905-3103. Epub 2019 Jul 9. PMID: 31288293; PMCID: PMC6988893.
42. Charest J, Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin. 2020 Mar;15(1):41-57. doi: 10.1016/j.jsmc.2019.11.005. PMID: 32005349.
43. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med. 2018 Mar;48(3):683-703. doi: 10.1007/s40279-017-0832-x. PMID: 29352373.
44. Covassin N, Singh P. Sleep Duration and Cardiovascular Disease Risk: Epidemiologic and Experimental Evidence. Sleep Med Clin. 2016 Mar;11(1):81-9. doi: 10.1016/j.jsmc.2015.10.007. Epub 2016 Jan 9. PMID: 26972035; PMCID: PMC4791534.
45. Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest. 2017 Aug;152(2):435-444. doi: 10.1016/j.chest.2017.01.026. Epub 2017 Jan 30. PMID: 28153671; PMCID: PMC5577359.
46. Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S; INCOSACT Initiative (International Collaboration of Sleep Apnea Cardiovascular Trialists). Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation. 2017 Nov 7;136(19):1840-1850. doi: 10.1161/CIRCULATIONAHA.117.029400. PMID: 29109195; PMCID: PMC5689452.
47. Krittanawong C, Tunhasiriwet A, Wang Z, Zhang H, Farrell AM, Chirapongsathorn S, Sun T, Kitai T, Argulian E. Association between short and long sleep durations and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2019 Dec;8(8):762-770. doi: 10.1177/2048872617741733. Epub 2017 Dec 5. PMID: 29206050.
48. Yin J, Jin X, Shan Z, Li S, Huang H, Li P, Peng X, Peng Z, Yu K, Bao W, Yang W, Chen X, Liu L. Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2017 Sep 9;6(9):e005947. doi: 10.1161/JAHA.117.005947. PMID: 28889101; PMCID: PMC5634263.
49. Makarem N, Alcántara C, Williams N, Bello NA, Abdalla M. Effect of Sleep Disturbances on Blood Pressure. Hypertension. 2021 Apr;77(4):1036-1046. doi: 10.1161/HYPERTENSIONAHA.120.14479. Epub 2021 Feb 22. PMID: 33611935; PMCID: PMC7946733.
50. Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, Jiang F. Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis. J Clin Sleep Med. 2015 Sep 15;11(9):1047-56. doi: 10.5664/jcsm.5024. PMID: 25902823; PMCID: PMC4543249.
51. Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR. The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus. Healthcare (Basel). 2019 Mar 5;7(1):37. doi: 10.3390/healthcare7010037. PMID: 30841553; PMCID: PMC6473416.
52. Anothaisintawee T, Reutrakul S, Van Cauter E, Thakkinstian A. Sleep disturbances compared to traditional risk factors for diabetes development: Systematic review and meta-analysis. Sleep Med Rev. 2016 Dec;30:11-24. doi: 10.1016/j.smrv.2015.10.002. Epub 2015 Oct 21. PMID: 26687279.
53. Grandner MA, Seixas A, Shetty S, Shenoy S. Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms. Curr Diab Rep. 2016 Nov;16(11):106. doi: 10.1007/s11892-016-0805-8. PMID: 27664039; PMCID: PMC5070477
54. Kim CE, Shin S, Lee HW, Lim J, Lee JK, Shin A, Kang D. Association between sleep duration and metabolic syndrome: a cross-sectional study. BMC Public Health. 2018 Jun 13;18(1):720. doi: 10.1186/s12889-018-5557-8. PMID: 29895272; PMCID: PMC5998453.