Sleep is an independent and modifiable risk factor for cardiovascular disease (CVD) , prompting a shift towards routine bidirectional screening in clinical practice. Experts concluded the Sleep Congress 2025 (19-21 November) in France.
Presentations underscored that measurable disturbances in sleep duration, quality, timing, and regularity have direct pathophysiologic effects that often precede or worsen conditions such as hypertension, atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD). Experts have urged clinicians to systematically evaluate sleep in patients with cardiac disease and assess the cardiovascular status of those with sleep disorders.
Eight Pillars of Cardiovascular Health
Detailing the American Heart Association’s Life’s Essential 8 framework, professor Atul Pathak, MD, PhD, of the National Institute of Cardiac Surgery and Interventional Cardiology (Haerz Zenter) in Luxembourg reaffirmed the formal inclusion of sleep. Pathak noted that each sleep component exerts distinct cardiovascular effects.
He illustrated this with the following four clinical scenarios.
- Resistant hypertension should prompt investigation for an absent nocturnal blood pressure dip (normally 10%-20%) and assessment beyond sleep apnoea or restless legs syndrome to include poor sleep quality, difficulty initiating sleep, nocturnal awakenings, and nocturia.
- Persistent AF is frequently associated with quantitative or qualitative sleep disturbances linked to left atrial dilation on echocardiography, preceding AF onset.
- HF is often associated with impaired central sleep regulation.
- CAD is promoted by both insufficient and excessive sleep durations.
Pathak called for a paradigm shift: “Any cardiovascular pathology should prompt investigation for a sleep disorders, not limited to sleep apnoea syndrome, and any sleep disorders should prompt a cardiovascular assessment, particularly for prevention.”
Sleep Health
Professor Jean-Arthur Micoulaud-Franchi, MD, PhD, of the University Sleep Medicine Service at University Hospital of Bordeaux, Bordeaux, France, promoted the concept of sleep health, defined not by the absence of disorder but by subjective satisfaction, sustained daytime vigilance, appropriate sleep timing, adequate duration, and high sleep efficiency.
He referenced the Grandner model, a multidimensional framework for understanding sleep quality across six domains: duration, regularity, timing, efficiency, satisfaction, and alertness. Four individual sleep quality factors are especially relevant for CVD risk:
- Irregular or fragmented sleep patterns, a major CVD risk factor even in the absence of sleep apnoea or insomnia, are often linked to work schedules. In women, this risk increases with long sleep duration, and in men, with short sleep duration.
- Daytime sleepiness that disrupts the daily activities of the patient.
- Irregularity of the sleep-wake cycle.
- Absence of restorative sleep.
Micoulaud-Franchi announced a forthcoming assessment of the cardiovascular impact of sleep disorders through a survey of 10 simple questions given to individuals with cardiac disorders.
Clinical Management
Sylvie Royant-Parola, MD, psychiatrist and president of the Réseau Morphée Network, a national French consortium that advances sleep health education and clinical training, outlined a structured approach to individuals with sleep disorders.
The first step is to help patients understand their sleep.
- Identify whether the sleep duration is short (< 6 hours) or long (> 9 hours).
- Review sleep patterns during holidays to observe natural sleep rhythms.
- Evaluating patterns during holidays and determining chronotypes.
- Recommended maintaining a sleep diary.
Clinicians should identify factors that negatively affect sleep quality and support individuals in correcting these factors.
- Use of medications and consumption of alcohol or tobacco.
- Diets high in sugar or fat before bedtime.
- Stress, anxiety, or depression.
- Evening behaviours, such as screen time, snacking, or working in bed.
- Insufficient physical activity or activity performed late in the evening.
- Limited exposure to daylight, which is common among individuals with insomnia and older adults. Light therapy is reserved for the winter.
Cognitive-behavioural therapy (CBT) for insomnia is the standard treatment. The most effective techniques include restricting time in bed with regular bedtimes and applying stimulus control strategies, such as getting up when sleep does not occur within approximately 15 minutes and rising immediately upon waking.
Daily physical activity for 20-30 minutes, relaxation, and meditation are also recommended. Smartphone programs that deliver these behavioural strategies are increasingly used in practice, and several are currently undergoing formal validation.
Drug therapy should only be offered when CBT for insomnia is ineffective. Royant-Parola recommended the Réseau Morphée and Le Monde du Sommeil websites, two sleep health resources that offer extensive information on sleep and its treatments, for further information.
Serge Cannasse December 11, 2025. https://www.medscape.com/
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