Association of Disrupted Delta Wave Activity During Sleep With Long-Term Cardiovascular Disease and Mortality

• Published in: Journal of the American College of Cardiology Vol. 83; no. 17; pp. 1671 - 1684
• Main Authors: Ai, Sizhi, Ye, Shuo, Li, Guohua, Leng, Yue, Stone, Katie L., Zhang, Min, Wing, Yun-Kwok, Zhang, Jihui, Liang, Yannis Yan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 30.04.2024
• Subjects: Aged; Cardiovascular; cardiovascular disease; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Delta Rhythm - physiology; delta wave activity; Female; Follow-Up Studies; Humans; Internal Medicine; Male; Middle Aged; mortality; Polysomnography - methods; Sleep - physiology; spectral entropy; cardiovascular disease; AHI; SHAP; PSG; EEG; AI; NREM; T90; WASO; CVD; spectral entropy; mortality; delta wave activity; CHD; BMI; non–rapid eye movement; arousal index; polysomnography; SHapley Additive explanation; body mass index; apnea-hypopnea index; electroencephalogram; time of sleep spent below 90% oxygen saturation; coronary heart disease; wake after sleep onset
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2024.02.040

Delta wave activity is a prominent feature of deep sleep, which is significantly associated with sleep quality. The authors hypothesized that delta wave activity disruption during sleep could predict long-term cardiovascular disease (CVD) and CVD mortality risk. The authors used a comprehensive power spectral entropy-based method to assess delta wave activity during sleep based on overnight polysomnograms in 4,058 participants in the SHHS (Sleep Heart Health Study) and 2,193 participants in the MrOS (Osteoporotic Fractures in Men Study) Sleep study. During 11.0 ± 2.8 years of follow-up in SHHS, 729 participants had incident CVD and 192 participants died due to CVD. During 15.5 ± 4.4 years of follow-up in MrOS, 547 participants had incident CVD, and 391 died due to CVD. In multivariable Cox regression models, lower delta wave entropy during sleep was associated with higher risk of coronary heart disease (SHHS: HR: 1.46; 95% CI: 1.02-2.06; P = 0.03; MrOS: HR: 1.79; 95% CI: 1.17-2.73; P < 0.01), CVD (SHHS: HR: 1.60; 95% CI: 1.21-2.11; P < 0.01; MrOS: HR: 1.43; 95% CI: 1.00-2.05; P = 0.05), and CVD mortality (SHHS: HR: 1.94; 95% CI: 1.18-3.18; P < 0.01; MrOS: HR: 1.66; 95% CI: 1.12-2.47; P = 0.01) after adjusting for covariates. The Shapley Additive Explanations method indicates that low delta wave entropy was more predictive of coronary heart disease, CVD, and CVD mortality risks than conventional sleep parameters. The results suggest that delta wave activity disruption during sleep may be a useful metric to identify those at increased risk for CVD and CVD mortality. [Display omitted]