The Link Between Sleep and Health

Featured Physician: Alberto Ramos, MD, MSPH, FAASM

Featured Article: Associations of Sleep Disordered Breathing and Insomnia with Incident Hypertension and Diabetes: The Hispanic Community Health Study/Study of Latinos

Dr. Alberto Ramos is a Board-Certified Neurologist and Associate Professor of Clinical Neurology and Research Director of the Sleep Disorders program at the University of Miami, Miller School of Medicine.  He has an interest in Hispanic community health and has specialized expertise on the effect of sleep disorders on other concurrent illnesses, such as diabetes and high blood pressure. He is also interested in the association between sleep disorders and Alzheimer’s disease and neurocognitive aging. 

In the interview below, Dr. Ramos shares with us some highlights from his paper looking at the connection of sleep disorders with hypertension and diabetes in the Hispanic community, but also discusses how his findings can be extrapolated to the general population at large. 

The Link Between Sleep, Diabetes, and High Blood Pressure

myDoqter: Thank you, Dr. Ramos, for sharing information about your study titled "Associations of Sleep Disordered Breathing and Insomnia with Incident Hypertension and Diabetes: The Hispanic Community Health Study/Study of Latinos" with the myDoqter Blog. The article was published in the American Journal of Respiratory Critical Care Medicine in August of 2020.

The results of the study offer very valuable health information for the Hispanic population, as well as for the rest of America, particularly as it shows how the quality and quantity of sleep can impact the incidence of diseases like diabetes and hypertension, and may also influence the onset of Alzheimer’s disease.

myDoqter: Do we know why sleep disorders are generally associated with hypertension and diabetes? 

Dr. Ramos: There are multiple studies in animals and humans suggesting that lack of sleep increases sympathetic tone, which means our nervous system releases adrenaline in high amount.This release of adrenaline leads to an increase in heart rate and blood pressure at night, that over time translates into the patient having hypertension. In addition, sleep deprivation increases the release of cortisol at night, and also changes appetite hormones that can contribute, over time, to obesity. All these things predispose patients to diabetes.

What is the Metabolic Syndrome and Who is at Risk? 

myDoqter: Can you talk to us about the Metabolic Syndrome and why are Hispanics more predisposed to having these issues? Does this apply to other ethnic groups as well? 

Dr. Ramos: Hispanics overall have an increased incidence of what are called ‘cardiometabolic’ disorders, such as obesity, hypertension and diabetes, when compared to non-Hispanic whites, for example. Sleep disorders are also highly prevalent in Hispanics/Latinos. Ongoing research points to sleep disorders as factors that can increase the risk of diabetes and hypertensionand, to some extent, this explains the disproportionate burden of these disorders in Hispanics. Of importance, sleep disorders are treatable and modifiable. Therefore, this may represent a great venue to prevent or ameliorate the effect of hypertension and diabetes in Hispanics and the population at-large.

Studying the Effects of Sleep Disorders in the Hispanic Community 

myDoqter: Can you describe how you studied the relationship between sleep disordered breathing and insomnia with hypertension and diabetes in Hispanics? 

Dr. Ramos: Our study was an analysis of the Hispanic Community Health Study/Study of Latinos, which is the largest health study of U.S. Latinos. In this particular analysis, we determined the effect of sleep apnea (a disorder characterized by snoring, pauses of breathing in sleep, sleepiness and fragmented sleep) and insomnia (difficulty falling asleep, staying asleep, with resulting non-restorative sleep) measured at baseline, on the incidence of hypertension and diabetes after 7 years of follow-up. The participants did not have diabetes or hypertension at baseline, meaning that they developed these disorders after the initial evaluation. We observed that the sleep disorders increased the risk of having new hypertension and diabetes, even taking into account multiple factors that could otherwise contribute to developing hypertension and diabetes, such as obesity.

myDoqter: What were your principal findings in the study? Were these findings expected?

Dr. Ramos: We did expect these findings. However, we did not expect that the associations or effect of sleep deprivation (lack of adequate sleep) with the development of hypertension and diabetes was as strong as seen in this analysis. 

myDoqter: What conclusions can we draw from this study? Do you think these findings can be extrapolated to other races, including African Americans? 

Dr. Ramos: We should continue to emphasize and educate all of our patients on important health matters so they can understand the importance of sleep in overall health. Physicians and patients should prioritize proper sleep in their assessments, as manydisorders can be treated, and even prevented, by practicing good sleeping habits. This can potentially have a profound effect on the health and well-being of all patients. Our findings are consistent with other studies that also observed an increased risk of cardiometabolic disorders associated with lack of sleep in African American patients.

Sleep and Alzheimer’s Disease 

myDoqter: Any final thoughts or comments on the study? Are there follow-up studies currently underway?

Dr. Ramos: We are evaluating how sleep affects cognitive function, cognitive aging and the risk of developing Alzheimer’s disease. Several studies have indicated the association between sleep deprivation and Alzheimer’s disease as well as other forms of dementia. We continue our studies and hope to achieve valuable scientific insight into this relationship, thus helping patients regain control of their overall health by reestablishing healthy sleep habits.

For more information about Dr. Alberto Ramos, you can also visit: https://doctors.umiamihealth.org/provider/Alberto+Rafael+Ramos/525412